Learn from what goes right: a demonstration of a new systematic method for identification of leading indicators in healthcare

The work in patient safety is often centred on adverse events and errors. Typical methods to improve patient safety are reactive and focus on understanding past failures. This article presents the development of a proactive method towards improving patient safety and understanding why processes function as intended on a daily basis. The paper presents the steps of how the method was developed and demonstrates it by using a former case study of early detection of sepsis. Emphasis is on understanding complex processes and identify aspects important for things going right and achieving intended outcomes. The study resulted in the development of six overall steps for identifying leading indicators in complex healthcare processes. These were (1) identification of relevant functions, (2) cluster of functions in sets, (3) identification of functions with variability, (4) identification of functions with upstream–downstream functions, (5) identification of leading indicators, and (6) confirmation of leading indicators through experts and adverse events. The study outlined the development a new method on the topic of leading indicators in the context of patient safety.