Shared meanings: preferred terms and definitions for safety and quality concepts

An early initiative of the Australian Council for Safety and Quality in Health Care (ACSQHC) was to set up a mechanism for reaching agreement on preferred terms and definitions for safety and quality concepts. The aim was to devise a language with common meanings to facilitate discussion and research.1 This need had been recognised before the Council was formed,2 and a group of international experts had been asked to comment on proposed terms and definitions (see Acknowledgements). The group was emailed proposals, along with alternative definitions from the literature, and asked their opinions and preferences, as well as any additional terms which should be considered. Their comments were circulated regularly among the group.

When ACSQHC was formed, I was asked to coordinate a process to advance this “Shared meanings” project. We created a website, listing terms with their preferred and alternative definitions, sources and comments on the definitions.3 Visitors to the site were invited to submit suggestions. In all, 149 terms and their preferred definitions were posted, with a further 296 alternate definitions, and 63 sources of information (eg, there were 16 definitions for “error”, 14 for “adverse event”, and five for “adverse drug event”). It was decided to choose terms and definitions with meanings as close as possible to those in colloquial use, and not to use terms which are potentially ambiguous (eg, “accident”, “complication”, “medicament”); 19 terms posted were designated “not for further consideration”.

A project group was then formed (see Acknowledgements), and a series of meetings held to decide on preferred terms and their definitions. The group decided to avoid long definitions with several “qualifiers”, but instead to start with simple, basic definitions, and then to “build” by defining the key terms used in these. It is therefore necessary to read the terms and their definitions in the sequence provided in Box 1; an alphabetically arranged list is given in Box 2.

In October 2004, the World Alliance for Patient Safety was launched under the auspices of the World Health Organization (WHO), and one of its first initiatives was to develop a classification for patient safety.4 At a meeting in October 2005, the WHO invited me to propose an underlying information model for this classification. The WHO classification group is hosting a web-based Delphi process5 to seek submissions from member countries as to which concepts should populate the classification and to propose preferred terms in their various languages. The ACSQHC terms and definitions shown in Box 2 have gained considerable currency (eg, many are used by the National Patient Safety Agency in the United Kingdom), and will be submitted for consideration for this worldwide patient safety classification, which is planned to become a member of the WHO Family of International Classifications.6