Article Text

Download PDFPDF
Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative
  1. Joanne Goldman1,
  2. Leahora Rotteau1,
  3. Virginia Flintoft2,
  4. Lianne Jeffs2,3,
  5. G Ross Baker2
  1. 1Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  2. 2Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
  3. 3Institute for the Science of Care and Innovation, Sinai Health System, Toronto, Ontario, Canada
  1. Correspondence to Dr Joanne Goldman, Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; joanne.goldman{at}utoronto.ca

Abstract

Background The Measurement and Monitoring of Safety Framework (MMSF) aims to move beyond a narrow focus on measurement and past harmful events as the major focus for safety in healthcare organisations. There is limited evidence of MMSF implementation and impact.

Objective We aimed to examine participants’ perspectives and experiences to increase understanding of the adaptive work of implementing the MMSF through a learning collaborative programme in diverse healthcare contexts across Canada.

Methods The Collaborative consisted of 11 teams from seven provinces. We conducted a qualitative study involving interviews with 36 participants, observations of 5 sites and learning sessions, and collection of documents.

Results Collaborative sessions and coaching allowed participants to explore reliability, sensitivity to operations, anticipation and preparedness, and integration and learning, in addition to past harm, and move beyond a project and measurement oriented safety approach. Participants noted the importance of time dedicated to engaging stakeholders in talk about MMSF concepts and their significance to their settings, prior to moving to implementing the Framework into practice. While participants generally started with a small number of ways of integrating the MMSF into practice such as rounds or huddles, many teams continued to experiment with incorporating the MMSF into a range of practices. Participants reported changes in thinking about safety, discussions and behaviours, which were perceived to impact healthcare processes. However, participants also reported challenges to sharing the Framework broadly and moving beyond its surface implementation, and difficulties with its sustained and widespread use given misalignments with existing quality and safety processes.

Conclusion The MMSF requires a dramatic departure from traditional safety strategies that focus on discrete problems and emphasise measurement. MMSF implementation requires extensive discussion, coaching and experimentation. Future implementation should consider engaging local leaders and coaches and an organisation or system approach to enable broader reach and systemic change.

  • qualitative research
  • patient safety
  • implementation science

Data availability statement

No data are available. Given the confidential qualitative data collected for this study, data sharing is not possible.

Statistics from Altmetric.com

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.

Data availability statement

No data are available. Given the confidential qualitative data collected for this study, data sharing is not possible.

View Full Text

Footnotes

  • Twitter @JoanneGoldman1, @VirginiaFlinto1, @baker_ross

  • Contributors All authors contributed to the conceptualisation and planning of this study and to development and writing of the manuscript. JG and LR were responsible for data collection and had a lead role in data analysis.

  • Funding This study was commissioned research by the Canadian Patient Safety Institute. There is no grant number.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.