Patients, clinicians and managers all want to
be reassured that their healthcare organisation is
safe. But there is no consensus about what we
mean when we ask whether a healthcare
organisation is safe or how this is achieved. In
the UK, the measurement of harm, so important
in the evolution of patient safety, has been
neglected in favour of incident reporting. The
use of softer intelligence for monitoring and
anticipation of problems receives little mention in
official policy. The Francis Inquiry report into
patient treatment at the Mid Staffordshire NHS
Foundation Trust set out 29 recommendations
on measurement, more than on any other topic,
and set the measurement of safety an absolute
priority for healthcare organisations. The Berwick
review found that most healthcare organisations
at present have very little capacity to analyse,
monitor or learn from safety and quality
information. This paper summarises the findings
of a more extensive report and proposes a
framework which can guide clinical teams and
healthcare organisations in the measurement
and monitoring of safety and in reviewing
progress against safety objectives. The
framework has been used so far to promote
self-reflection at both board and clinical team
level, to stimulate an organisational check or
analysis in the gaps of information and to
promote discussion of ‘what could we do
differently’.