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22 Well begun is half done
  1. Jason Boulanger1,
  2. Evan Benjamin2,
  3. Rachel Moyal-Smith2,
  4. Patricia Folcarelli2
  1. 1CRICO
  2. 2Ariadne Labs


Background While many patient safety initiatives have successfully reduced harm in individual facilities and organizations, implementation, sustainment, and spread of these initiatives lags across the healthcare system.

Objectives To address this implementation gap, we created the Patient Safety Adoption framework, identifying and providing guidance for achieving the key elements of implementation (figure 1).

Methods The Framework for Implementation describes the required strategy and structure to achieve effective implementation that stewards meaningful change. It is based on extensive literature reviews and an exhaustive series of six focus groups and 20 individual interviews with CRICO members. Ariadne Labs then conducted face validity testing, a review to test the extent to which the framework appears effective in terms of its stated aims.

Results The framework’s domains are:

  • Leadership: Essential functions for leaders to support implementation, including governance, prioritization, and accountability.

  • Culture and Context: setting the norms and expectations that create an atmosphere in which everyone feels responsible for safety and pursues it daily.

  • Process: the interrelated actions that are vital to transform ideas into a tangible solution on the ground.

  • Meaningful Measurement: creating measures that are actionable, feasible, streamlined, and focused on improving the most crucial aspects of patient care.

  • Person-Centeredness: creating mutually beneficial partnerships between patients, their families and those delivering health care services.

Conclusions The patient safety adoption framework will be used to help guide patient safety implementations across institutions, ensuring all key elements are addressed by:

  • providing leadership, implementation teams, and others with a shared language and understanding of implementation for communicating and planning together; and

  • assessing readiness for implementation and targeting areas needing improvement with the accompanying implementation readiness questions.

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