The third national trigger tool workshop was held on 9 March 2015 at Ko Awatea in Auckland, and was sponsored by the Health Quality & Safety Commission and First, Do No Harm. The workshop was attended by approximately 60 people, including teams from 12 district health boards (DHBs) and private provider Southern Cross Hospitals.

The theme for the workshop ‘Getting a handle on patient harm – how do you know your systems are safe?’ reflects the journey the Commission’s trigger tool programme has taken over the past three years, from implementing trigger tools, to using data for improvement, and now using trigger tools in the broader context of patient safety.

In New Zealand, trigger tools are used by a number of hospitals, and a primary care trigger tool has recently been trialled by a number of primary care practices in the Auckland region.

For our first workshop in 2013 the focus was on implementing the Global Trigger Tool (GTT) as part of a suite of tools that hospitals could use as sources of information about patient harm. In 2014 the focus moved to using data for improvement – how we could best use data from GTT reviews to inform improvement initiatives. In 2015, we broadened our approach to think about how trigger tool data should be routinely incorporated into an organisation’s approach to learning from harm and taking appropriate action to improve the system across both the secondary and primary care sectors.

Lightning talks

In 2015 we used the concept of lightning talks to share experiences. Hospital teams were asked to use three slides and talk for three minutes to address the following questions.

  1. What’s working (what value are you getting out of using the ADE / GTT in your organisation)?
  2. What’s not working (what is stopping you getting ‘traction’ with using GTT data for change)?
  3. How could it work (what do we need to get a better handle on measuring and monitoring patient harm)?

Teams were encouraged to be creative and have some fun and as a result we had 12 excellent presentations – Waikato DHB was voted the best.

Lessons from primary care

Keynote speaker Dr Beven Telfer talked about how trigger tools are used in primary care as a reflective process. Dr Telfer, clinical lead for the Auckland region primary care safety in practice collaborative talked about trigger tools creating a focus on patient safety, and how they generate valuable staff discussion about ways to improve system safety and reliability.

Like in hospitals, the trigger tool process involves a systematic review of a random sample of records to identify patient harm. Unlike hospitals, the process is undertaken only two or three times a year on a randomly selected sample of 25 medical records from an identified high risk patient cohort.

The learning process involves sharing the identified patient harms and other incidental findings at practice meeting using a reflective process. This generates valuable discussions about ways to improve system safety and reliability.

A new framework for sharing learning from trigger tools

Ashika Maharaj, trigger tool lead at Counties Manukau DHB discussed how the primary care approach could be applied in hospitals. She presented a simple framework for hospitals to use to enhance learning from trigger tool data.

The framework offers a way of engaging frontline clinicians by presenting cases for discussion and reflecting on what can be learned, as well as bringing the patient experience to the forefront.

View Ashika's presentation and the framework template

Exploring additional options

Karen O’Keeffe, clinical director at First, Do No Harm and and director of nursing at Whangarei Hospital. Karen recently developed an interest in how coding data has the potential to complement trigger tool data as a source of information about patient harm.

View Karen's presentation


The workshop was well received and the value of using trigger tools substantiated. Our thinking about how trigger tools can be used was broadened and a new tool was introduced to support teams in using the data for learning.

Last updated 13/10/2016