The quest for ‘‘harm free’ care is new and can only be delivered through setting up measurement systems which prompt your frontline teams to think differently - measuring harm from the patients’ perspective and not from the healthcare providers.

In all healthcare systems we count the number of pressure ulcers, falls etc and on the diagram below this is like counting downwards in vertical columns, for example, two of five patients had a pressure ulcer (40%).

In ‘harm free’ care we want to change this and start counting patients ‘protected from harm’, in the pressure ulcer example this would be three of five patients (60%) if we count in the usual way.  We can raise the bar even further by starting to count across at the level of the individual patient to determine how many patients had none of the four harms i.e. were harm free from these conditions (harm free composite).

To explain this further, in the example below, out of five patients, only two, patients three and four (highlighted in blue) were protected from all four harms.