1. What do we mean by harm? Charles Vincent Department of Experimental Psychology, Nuffield Department of Surgical Sciences University of Oxford

2. What do we mean by u Harm is defined relative to current standards of care u Harm looks different to different people and at different levels of the system u Usually thought of as relatively circumscribed events – Hospital based (for the most part) – They have a history, but a short one – Observed by healthcare professionals

3. Incidents within a patient journey (Healthcare professionals’ view) Good care + incidents

4. Patient harm happens in every healthcare setting: at home in convalescence, in an operating room under anaesthesia, at the lab getting blood drawn, in the hospital corridor lying alone on a stretcher …… Harm may result from wrong or missed diagnosis, scheduling delay, poor hygiene, mistaken identity, unnoticed symptoms, hostile behaviour, device malfunction, confusing instructions, insensitive language and hazardous surroundings. The trajectory of harm begins with the unexpected experience of harm arising from or associated with the provision of care, including acts of both commission and omission……... The patient may experience harm during the episode of care when the failure occurred, or later, after some time has passed. Harm as it is first endured may evolve, transform and spread (Canfield, 2013)

5. Harm through the patient’s eyes u Harm is conceived very broadly encompassing both serious disruption of treatment and distressing events. u Harm includes serious failures to provide appropriate treatment as well as harm that occurs over and above the treatment provided. u Harm is seen not in terms of incidents but as a trajectory within a person’s life.

6. A broader view of harm u Treatment specific harm u Harm due to over treatment u General harm from healthcare u Harm due to failure to provide appropriate treatment u Harm due to failed or inadequate diagnosis u Psychological harm and feeling unsafe u Harm due to neglect and dehumanisation

7. Explore dimensions of harm in each setting u Hospital acquired syndromes in care of the elderly – Dehydration – Malnutrition – Delirium – Depression – Pressure sores – Incontinence

8. Questions 1. What do we mean by harm? 2. How much of this do we currently measure? 3. What should we measure?