Patient Safety Really is Improving

Research carried out by CLAHRC WM colleagues showed, mainly on the basis of process measures, that hospital care in the UK became safer over the ‘Blair Decade’.[1] [2] Now an even larger Dutch study, 2005-2013,[3] has produced corroborating findings with respect to adverse events. Both studies were based on case-note review. The Dutch study found an approximately one-third reduction in adverse events on retrospective review of nearly 16,000 case-notes. So, there are now two separate studies that have used a consistent methodology over time and both suggest that care is becoming safer. This is probably the result of national initiatives and diffusion of safety ideas among clinicians. Indeed one of the reasons put forward for failure to find a statistically significant effect from the Safer Patients Initiative in the UK was the system-wide temporal trend, or ‘rising tide’.[4] There are good arguments to conduct a further follow-up of safety in UK hospitals to see if the improvement noted over the first decade of the millennium has been sustained. This might be the last chance, since case-note review may become more difficult as the future case record is fragmented across hospital IT systems.

— Richard Lilford, CLAHRC WM Director


  1. Benning A, Ghaleb M, Suokas A. Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation. BMJ. 2011; 342:d195.
  2. Benning A, Dixon-Woods M, Nwulu U, et al. Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase. BMJ. 2011; 342:d199.
  3. Baines R, Langelaan M, de Bruijne M, Spreeuwenberg P, Wagner C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Qual Saf. 2015; 24: 561-71.
  4. Chen Y, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2015. [ePub].

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