Article Text

Download PDFPDF

Measurement and monitoring of safety: impact and challenges of putting a conceptual framework into practice
  1. Eleanor Chatburn1,
  2. Carl Macrae1,
  3. Jane Carthey2,
  4. Charles Vincent1
  1. 1 Department of Experimental Psychology, University of Oxford, Oxford, UK
  2. 2 Jane Carthey Consulting, London, UK
  1. Correspondence to Professor Charles Vincent, Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK; charles.vincent{at}


Background The Measurement and Monitoring of Safety Framework provides a conceptual model to guide organisations in assessing safety. The Health Foundation funded a large-scale programme to assess the value and impact of applying the Framework in regional and frontline care settings. We explored the experiences and reflections of key participants in the programme.

Methods The study was conducted in the nine healthcare organisations in England and Scotland testing the Framework (three regional improvement bodies, six frontline settings). Post hoc interviews with clinical and managerial staff were analysed using template analysis.

Findings Participants reported that the Framework promoted a substantial shift in their thinking about how safety is actively managed in their environment. It provided a common language, facilitated a more inquisitive approach and encouraged a more holistic view of the components of safety. These changes in conceptual understanding, however, did not always translate into broader changes in practice, with many sites only addressing some aspects of the Framework. One of the three regions did embrace the Framework in its entirety and achieved wider impact with a range of interventions. This region had committed leaders who took time to fully understand the concepts, who maintained a flexible approach to exploring the utility of the Framework and who worked with frontline staff to translate the concepts for local settings.

Conclusions The Measuring and Monitoring of Safety Framework has the potential to support a broader and richer approach to organisational safety. Such a conceptually based initiative requires both committed leaders who themselves understand the concepts and more time to establish understanding and aims than might be needed in a standard improvement programme.

  • patient safety
  • qualitative research
  • safety culture
  • quality measurement

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors CV oversaw the project and CV and EC designed the study. EC conducted the interviews. EC, CM and JC contributed to the data analysis. EC and CV wrote the initial draft of the present paper. All authors critically reviewed and approved the final manuscript.

  • Funding This study was funded by The Health Foundation.

  • Competing interests JC runs workshops on the Measurement and Monitoring of Safety Framework.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.