New Model for Measuring Patient Safety

Löf, the mutual insurance company for Swedish regions, has developed a new model designed to simplify the measurement of patient safety efforts and their effectiveness across different healthcare settings. The initiative aims to bridge a gap in how healthcare providers track the impact of safety measures, moving beyond broad national statistics to provide actionable data at the operational level.

While various indicators exist for reporting patient safety at international, national, and regional levels, there has been a lack of specific metrics tailored for individual operational units. The new model, which is based on the Swedish National Board of Health and Welfare’s (Socialstyrelsen) national action plan for patient safety, provides concrete examples of metrics tailored to specific types of medical activities.

Tailoring Metrics to Clinical Settings

The model recognizes that a single metric cannot accurately reflect safety across all healthcare environments. For example, healthcare-associated infections have long served as a general measure of patient safety. While this metric is highly relevant for inpatient somatic care, where such infections are the most common avoidable harm, it is not an applicable measure for other settings.

According to Pelle Gustafson, chief physician at Löf and medical editor for Läkartidningen, infections are a total irrelevant measure for emergency departments, primary care, and psychiatry. In those specific environments, indicators such as diagnostic errors are considered more significant and relevant for assessing safety.

The model suggests different indicators based on the specific nature of the facility, offering examples for:

• Psychiatry
• Pediatric care
• Nursing homes for the elderly
• Surgical disciplines
• Primary care

Certain metrics remain universal across all operations, such as the overall patient safety culture and the level of engagement from leadership.

Development and Data Integration

To ensure the model’s relevance, Löf consulted with a variety of stakeholders, including regional chief physicians, leaders of large private healthcare operations, primary care center managers, and patient safety coordinators at children’s clinics. A primary goal was to ensure that the proposed metrics rely on data that can already be extracted from existing healthcare systems.

These consultations also highlighted the need to track the impact of bed shortages. Gustafson noted that while it is known when patients are denied a hospital bed, there is often little data on the outcomes for that specific group. The model suggests tracking how many patients denied a bed have a new healthcare contact within 24 or 48 hours as a way to measure the risk associated with lack of capacity.

Reducing Administrative Burden

The model is intended to prevent healthcare staff from spending excessive time on reporting that does not provide clinical value. Gustafson stated that the intention is to avoid situations where staff spend hours attempting to feed the beast, emphasizing that the metrics should focus on information that providers actually want to monitor to improve care.

The response to the model has been described as overwhelmingly positive, with feedback indicating that it feels relevant and well-considered at the operational level. Future expansions of the model may include additional areas such as dental care and prehospital care.

While the ability to measure certain metrics over time has improved, Gustafson noted that there is still significant work to be done as the healthcare system continues to identify which specific types of harm are most common within different types of medical operations.