The Commission has developed and continues to support a work programme to encourage the use of trigger tools in New Zealand.

Trigger tools are ways of identifying and documenting patient harm using a systematic record review process on a randomly selected set of medical records using triggers as flags for patient harm. It has a focus on team-work as the methodology requires medical record reviews to be carried out by a team of trained reviewers who have a clinical background.

The purpose is not only to count harms but more importantly to identify themes so that steps can be taken to minimise the risk of harm and to improve the patient experience of care. Trigger tools have been shown to identify up to ten times more harm than traditional approaches such as voluntary reporting. This approach typically identifies the more common every day ‘harms’ that impact on the patient experience but which don’t reach the threshold for reporting. Trigger tools should therefore be regarded as complementary to other reporting approaches.

The Commission's Trigger Tool programme began with the Global Trigger Tool (GTT) in 2012 with a focus on establishing GTT as part of a suite of tools hospitals would use to identify patient harm. GTT was developed by the Institute for Health Care Improvement (IHI) and is used internationally as an approach to identifying and documenting patient harm. In New Zealand, Trigger tools are being used by a number of hospitals and a primary care trigger Tool has been trialled by a number of primary care practices in the Auckland region.

Trigger tools are a simple, cost effective methodology and have been widely used both in hospitals and general practices to identify, quantify and track patient harm in order to improve the quality and safety of services provided.


Carol Haraden is the Vice President of the Institute of Healthcare Improvement (IHI). IHI developed the Global Trigger Tool which the Commission is encouraging all DHBs to implement. The Commission is working to publish helpful resources to assist with implementation. In the short AV below, Carol is interviewed about patient safety at the Asia Pacific Forum (APAC) and asks why clinicians aren’t using a standardised approach to patient safety issues. She also talks about the importance of team-work in achieving improved patient safety.

Last updated 11/05/2017