Patient Safety Indicator Sets: Prioritization, Decision-Making Considering Healthcare Resilience, and Implementation Success

Patient safety indicators are core measures for improving healthcare. We aimed to conceptualize the prioritization of such indicators and the requirements for developing a core set of nationwide, valid, low-bureaucracy patient safety indicators. We also aimed to develop a decision aid for adapting the core set to strengthen the resilience of healthcare provision with respect to crisis situations and to identify factors related to successful implementation. A hybrid focus group design of 4 guided online focus group interviews was used by combining a semi-structured discussion and supporting materials, including questionnaires. The data were analyzed using content and descriptive analysis. A framework for prioritizing patient safety indicators for core set development and adaptation was developed. Indicator prioritization is guided by the aim of the core set, considering stakeholders' needs, potential for improvement, context of use, scientific quality, and implementability criteria. Together with the requirement criteria, such as patient safety dimensions, the breadth and depth of the indicator set can be defined. The developed decision aid for crisis events was deemed suitable for maintaining patient safety. A modular system is recommended for the adaptation of the core set to address several different indicator measurement scenarios. The developed framework and decision aid allow context-(in)dependent prioritization on the basis of the criteria for prioritizing patient safety indicators for a core indicator set and for indicator decision-making in adapting the core set for crisis events. Further real-world validation of the framework and decision aid and the associated criteria is recommended.