Table 1.

Description of the five dimensions of safety (adapted from Vincent et al. [2])

MSS dimension	Purpose	Examples
‘Past harm’ Has patient care been safe in the past?	Assess rates of past harm to patients	Patient record review Adverse event reports
‘Reliability’ Are clinical systems and processes reliable?	Assess the reliability of safety critical processes and the ability of staff to follow these procedures	Observations of safety critical behaviour Practice safety checklist
‘Sensitivity to operations’ Is care safe today?	Support the monitoring of safety on an hourly or daily basis	Observations and conversations with practice staff Talking to patients
‘Anticipation and preparedness’ Will care be safe in the future?	Support the anticipation and respond to future threats to safety	Safety climate assessment Structured reflection
‘Integrating and learning’ Are we responding and improving?	Analyse and use safety information to improve safety	Aggregate data on patient complaints Feedback and implementation of safety lessons