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A framework for classifying patient safety practices: results from an expert consensus process
  1. Sydney M Dy1,
  2. Stephanie L Taylor2,3,
  3. Lauren H Carr4,
  4. Robbie Foy5,
  5. Peter J Pronovost1,
  6. John Øvretveit6,
  7. Robert M Wachter4,
  8. Lisa V Rubenstein2,3,
  9. Susanne Hempel2,
  10. Kathryn M McDonald7,
  11. Paul G Shekelle2,3
  1. 1Johns Hopkins University, Baltimore, Maryland, USA
  2. 2RAND Corporation, Santa Monica, California, USA
  3. 3Veterans Administration, Greater Los Angeles, Los Angeles, California, USA
  4. 4University of California, San Francisco, San Francisco, California, USA
  5. 5University of Leeds, Leeds, UK
  6. 6The Karolinska Institute, Stockholm, Sweden
  7. 7Stanford University, Stanford, California, USA
  1. Correspondence to Sydney Dy, Johns Hopkins University, Rm 609, 624 N Broadway, Baltimore, MD 21090, USA; sdy{at}


Objective Development of a coherent literature evaluating patient safety practices has been hampered by the lack of an underlying conceptual framework. The authors describe issues and choices in describing and classifying diverse patient safety practices (PSPs).

Methods The authors developed a framework to classify PSPs by identifying and synthesising existing conceptual frameworks, evaluating the draft framework by asking a group of experts to use it to classify a diverse set of PSPs and revising the framework through an expert-panel consensus process.

Results The 11 classification dimensions in the framework include: regulatory versus voluntary; setting; feasibility; individual activity versus organisational change; temporal (one-time vs repeated/long-term); pervasive versus targeted; common versus rare events; PSP maturity; degree of controversy/conflicting evidence; degree of behavioural change required for implementation; and sensitivity to context.

Conclusion This framework offers a way to classify and compare PSPs, and thereby to interpret the patient-safety literature. Further research is needed to develop understanding of these dimensions, how they evolve as the patient safety field matures, and their relative utilities in describing, evaluating and implementing PSPs.

  • Patient safety
  • patient safety practices
  • medical errors

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  • The authors of this paper are responsible for its content. Statements in this paper should not be construed as endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.

  • Funding The research reported here was supported under Contract No. HHSA-290-2009-10001C from the Agency for Healthcare Research and Quality, US Department of Health and Human Services.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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