Safe Practices for Better Healthcare 

Every patient deserves safe healthcare and should have the utmost confidence they will not be harmed in the places they go for care. While improvements have been made in patient safety they must spread farther and faster.

To guide healthcare systems in providing safe care NQF maintains a set of Safe Practices for Better Healthcare. The evidence-based safe practices are ready-to-use tools to improve safety and have been evaluated, assessed and endorsed to guide large and small healthcare systems in providing the safest care possible.

To accelerate adoption of the practices NQF produces a manual that includes the latest safety evidence, implementation strategies, and guidance for patient and family involvement in safe care. NQF also hosts periodic educational webinars on safety and safe practices, and aligns its other safety work with the safe practices.

Our Challenge. Our Opportunity. 

Medical errors cause significant harm to patients in healthcare settings across the country.

  • In 2008, the Agency for Health Care Research and Quality (AHRQ) reported that preventable medical injuries are actually on the rise—by one percent a year.1 
  • Healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year.2 
  • At least 1.5 million preventable drug events occur each year due to drug mix-ups and unintentional overdoses.
  • Eighteen types of medical errors account for 2.4 million extra hospital days and $9.3 billion in excess charges each year.3 

The harm can also be measured in heavy financial cost. Preventable errors have been estimated to cost the United States $17 - $29 billion per year in healthcare expenses, lost worker productivity, lost income and disability.4 Meanwhile, healthcare expenditures are growing at more than seven percent per year and patient safety is improving by only one percent.5 

The good news is that with Safe Practices healthcare systems have a key to truly drive improvement in quality and patient safety.

Timeline of Safe Practices 

Safe Practices for Better Healthcare is one of NQF’s longest running endorsement projects. The practices are regularly updated to reflect new evidence, and have gone multiple iterations. The practices remain important tools to guide safe healthcare across providers and settings.

2003: NQF endorses the initial set of 30 Safe Practices (2003 manual).

2006: The original Safe Practices are updated with new evidence. Safe Practices are added to address leadership and staffing, and the practices are harmonized with safety initiatives from other national groups such as the CMS, AHRQ, and the Joint Commission. Thirty-four Safe Practices are endorsed. (2006 manual)

2009: New Safe Practices are added to address pediatric imaging, organ donation, caring for caregivers and glycemic control and falls prevention. To increase adoption, all practices are rewritten to give health professionals direct ownership and accountability for the practices. (2009 manual)

2010: The list of Safe Practices remains the same as in 2009, but the practices are updated with latest evidence. The Safe Practices manual is updated to provide additional guidance on implementation and patient and family engagement. (2010 manual)


To accelerate adoption of best practices to improve safety, a series of webinars were held in 2009 to guide implementation of the practices. Video and audio from past webinars are available on the Texas Medial Institute of Technology (TMIT) website. TMIT continues to host implementation webinars on Safe Practices that feature experts from across the country. Information about upcoming webinars is available through TMIT’s website.

Additional Resources 

NQF’s Safe Practices for Better Healthcare is a companion piece to Serious Reportable Events (SREs) in Healthcare. In 2002, NQF endorsed the first set of SREs. That list was updated in 2006 and is currently being updated. NQF expects to endorse an updated list of SREs in early 2011. Right now, the list of Serious Reportable Events includes 28 adverse events that are serious, largely preventable and of concern to healthcare providers, consumers and all stakeholders.


1 Sorra J, Famolaro T, et al. Hospital Survey on Patient Safety Culture 2008 Comparative Database Report. AHRQ Publication No. 08-0039. Rockville, MD: Agency for Healthcare Research and Quality, 2008.

2 Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007 Mar-Apr;122(2):160-6.; Yokoe DS et al. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. ICHE 2008; 28(1) S12-21.

3 Zhan C, Miller MR. Excess length of stay, charges, mortality attributable to medical injuries during hospitalization, JAMA, 2003;290(14):1868-1874.

4 IOM, To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

5 Catlin A, Cowan C, Heffler S, et al., National health spending in 2005: the slowdown continues, Health Affairs, 2007;26(1):142-153.