Researching patient safety in primary care: Now and in the future

If we were to paraphrase Voltaire ' s quote on God, we could certainly say that in respect of patient safety it is a circle whose centre is everywhere and whose circumference is nowhere. Over the past 10 years, there has been a huge volume of data collected on medical error and harm to patients. With many tragic cases of health-care failure and a growing number of major government and professional reports on the need to make healthcare safer, there has been a recognition that patient safety should be at the centre of healthcare. However, if we were to ask whether patients were any safer than they were 10 years ago, the answer would be elusive. We certainly have not been able to put a circumference around the circle of patient safety. This supplement, like much research, raises more questions than it answers. What it does achieve is to identify the key challenges facing researchers seeking to understand the complexity of patient safety in the primary care setting and map out a possible future research agenda. However, it is also worth asking some searching questions on the key issues facing us today. There are fi ve key questions that we need to ask when considering whether a healthcare organization in primary care is safe. Has patient care been safe in the past? Are our clinical systems and processes reliable? Is care safe today? Will care be safe in the future? Are we responding and improving? These questions have been developed into a framework of fi ve dimensions to help understand how we can measure and monitor safety in the healthcare setting: past harm, reliability, sensitivity to operations, anticipation and preparedness and integration and learning (1). How relevant are these dimensions to primary care? We clearly need to understand a lot more about the defi nition, epidemiology and type of patient safety incidents that occur in primary care because this will be essential to understanding past harm and determining whether we are improving (2). This remains a challenge for the patient safety research agenda and primary care researchers need to address this defi cit in their countries because the heterogeneity of primary care systems in Europe means that results will probably only be applicable locally. The emphases on strengthening systems and on learning are highlighted in several papers in this supplement. Unfortunately, reliability and sensitivity to operations requires an infrastructure that …