Developing a patient measure of safety (PMOS)

BMJ Qual Saf. 2013 Jul;22(7):554-62. doi: 10.1136/bmjqs-2012-000843. Epub 2013 Feb 27.


Background: Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS).

Methods: Thirty-three qualitative interviews with a representative sample of patients from six units in a teaching hospital in the north of England were carried out. Patients were asked either to describe their most recent/current hospital experience (unstructured) or were asked to describe their experience in relation to specific contributory factors (structured). Responses were coded using the YCFF. Face validity of the PMOS was tested with 12 patients and 12 health professionals, using a 'think aloud' approach, and appropriate revisions made. The research was supported by two patient representatives.

Results: Patients were able to comment on/identify 13 of the 20 contributory factors contained within the YCFF domains. They identified contributory factors relating to communication and individual factors more frequently, and contributory factors relating to team factors, and support from central functions less frequently. In addition, they identified one theme not included in the YCFF: dignity and respect. The draft PMOS showed acceptable face validity.

Discussion: Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements.

Keywords: Health services research; Patient safety; Patient-centred care; Safety culture.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • England
  • Female
  • Hospitals, Teaching / standards
  • Humans
  • Male
  • Middle Aged
  • Patient Participation*
  • Patient Safety*
  • Patient Satisfaction*
  • Process Assessment, Health Care / methods*
  • Professional-Patient Relations
  • Quality Indicators, Health Care
  • Safety Management / standards*
  • Young Adult