Table 1

Review of existing conceptual frameworks

Framework authorDomainsExamples of interventions and influences
Brown et al5Structure (organisation of healthcare systems)National contextual factors, policies and resources
Generic interventions targeting management and organisational processesHuman resource policy, training of new staff
Specific interventions targeting clinical processesAdoption of particular safety/evidence-based practices; quality of clinician–patient communication
Øvretveit (2010)6 7Clinical safety practices (specific actions taken by care providers in their work to reduce certain types of adverse events experienced by patients)Hand-hygiene practices; use of ‘bundles’ (eg, to reduce ventilator associated pneumonia)
Implementation actions (what managers and others do to put safer care practices into everyday operations; usually time-limited)Creation of policies, procedures and protocols; education and training; publicity campaigns
Generic safety interventions (creation of favourable conditions to choose, implement and support safety practices, and create safer environments)Information systems for collecting safety data; a safety committee reviewing adverse events; finance systems which reward safer care
Agency for Healthcare Research and Quality Patient Safety Network8Communication improvementCommunication between providers; provider–patient communication
Culture of safetyJust culture; learning organisation
Education and trainingPatient education; simulators
Error reporting and analysisError analysis; error reporting
Human factors engineeringChecklists; medical device design
Legal and policy approachesIncentives; malpractice litigation; regulation
Logistical approachesDuty hour limitation; nurse staffing ratios
Quality improvement strategiesAudit and feedback; practice guidelines; continuous quality improvement
Specialisation of careClinical pharmacist involvement; specialised teams
TeamworkTeamwork training
Technological approachesBar coding; clinical information systems
Quest for Quality and Improved Performance9Healthcare delivery modelsPrimary care; acute care
Organisational interventionsProfessional behaviour change; continuous quality improvement; performance measurement and reporting
Data-driven and IT-based interventionsPerformance monitoring and feedback; decision support for clinicians
IncentivesMonetary rewards for organisations; earned autonomy
Regulatory interventionsProfessional credentialing; institutional accreditation
Patient-focused interventionsInterventions to improve safety, shared decision-making and self care
Cochrane Effective Practice and Organisation of Care Group10Professional interventionsEducational meetings; audit and feedback; reminders
Financial interventionsInstitution incentives and penalties; provider incentives
Organisational interventionsRevision of professional roles; changes in medical records systems; changes in physical structure, facilities and equipment
Regulatory interventionsChanges in medical liability; licensure
Multilevel framework (Ferlie and Shortell)11Larger system/environmentAccrediting agencies; legal systems
OrganisationalQuality assurance; organisational learning
Team levelTeam redesign; breakthrough collaboratives
Individual levelAcademic detailing; guideline implementation