1. Gould, Kathleen Ahern RN, MSN, PhD

Article Content


Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.

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The Institute for Healthcare Improvement, a leader in health and health care improvement worldwide, collaborated with Safe & Reliable Healthcare, an organization at the forefront of measuring and improving culture and building highly reliable learning systems. Together, over a 15-year period, these groups worked to create and refine the framework described in this white paper. The finished work is a tribute to the collaborative relationships and commitment to transform care. This work empowers learning toward creating systems of safety. The article may serve as an outline or design for a practical framework for how a health care organization or system can move toward a consistent and reliable progression in safety.


In the white paper, the authors address 2 foundational domains, culture and the learning systems. Additionally, they describe 9 interrelated components, with patients and families as a central theme. The framework reflects the strategic and operational concepts that guide decisions and planning for clinical practice models. Within this learning system, the article presents 4 main responsibilities for health care leaders. These include guarding the learning system, creating psychological safety, fostering trust, and ensuring value alignment. As these concepts are discussed, clinical examples and exemplars illustrate how to address concerns about safety and reliability using improvement science. Specifically, the Model for Improvement is a systematic methodology with subject-matter knowledge to create the desired improvements. The model comprised 3 questions and a Plan-Do-Study-Act cycle for testing changes to assess whether they lead to improvement.


The article includes an appendix with an esteemed resource list for select patient safety methods and tools. The reference list provides sentinel articles in the field of improvement science. It is a valuable resource for all organizations and health care leaders.



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