Table 1

MMSF dimensions and examples

MMSF dimensionExamples of approaches
Past harm: Has patient care been safe in the past?Safety measurement in this dimension focuses on past harm to patients, both physical and psychological. Sometimes described by its authors as measuring and monitoring safety through ‘the rear-view mirror,’ examples of types of safety data in this dimension are incident reports, incident investigations, mortality reviews, complaints, and so on.
Reliability: Are our clinical systems and processes reliable?Safety measurement on the reliability dimension focuses on identifying weaknesses and gaps in a wide range of clinical systems. Referred to by the MMSF authors as the ‘leaking tap’ dimension of the MMSF, examples of reliability measures include, (among many others), equipment availability in operating theatres, compliance with care bundles, whether patients receive the correct medications on time, and so on.
Sensitivity to operations: Is care safe today?The focus in this dimension is moment-to-moment, hour-by-hour tuning into safety through conversations, observations, perceptions and real-time safety data. This is the looking, listening and perceiving dimension of the MMSF, where safety intelligence is gathered through conversations and observations.
Anticipation and preparedness: Will care be safe in the future?Anticipation and preparedness is the horizon-scanning dimension of the MMSF. It involves, for example, using leading indicators and/or real-time data to anticipate, and thwart emerging problems and threats to safety. Anticipation and preparedness can also involve looking at data sets which are not safety metrics through a safety lens: For example, statutory and mandatory training data, workforce metrics like staff turnover or staff vacancy rates, or operational data on referral rates and admissions.
Integration and learning: Are we responding and improving?The integration and learning dimension relates to how disparate sources of quantitative and qualitative safety information are interpreted, fed back and used to inform safety improvement work. Examples include how patient safety information is presented on dashboards and what feedback mechanisms are in place to ensure what is learnt translates into safety improvement.
  • MMSF, Measurement and Monitoring of Safety Framework.