Basic problem factors are factors that might contribute to the occurrence of a patient safety incident. Mark-Alexander Sujan, associate professor of patient safety at Warwick Medical School, and his colleagues originally developed the PRIMO tool and identified several BPFs that might relate to a given work setting, such as staffing. The BPFs form the basis of the question topics that can be seen in the PRIMO questionnaire. When using PRIMO, all of BPF questions can be used initially, or the ones that are relevant to individual places of work can be selected. Establishing which ones to use can be done by reviewing them with the team, examining incident reports or asking staff to describe recent work problems.

Once the BPFs have been decided, it is time to gather the data. A paper or electronic version of the questionnaire should be given to staff to complete. Whichever way the questionnaire is distributed, staff responses should remain anonymous. Once completed, the mean score across all respondents for each BPF or individual question should be calculated. A high mean score indicates organisational factors that are particularly challenging and warrant further investigation or improvement. Exploring any comments that staff have included in the questionnaire can be done to drill down into why particular factors in the environment are troublesome. This prioritisation is useful as it is often difficult to know where to start when improving patient safety. Sometimes the prioritised BPFs will be found as ones that have been identified in previously reported patient safety incidents.

Now it should be clear where there are particular issues or challenges within the organisation in relation to safety. Some issues may be easily rectified and therefore are ‘quick wins’, and others may require greater input and take longer to change and improve. Any changes made will be specific to the team. Ways to make changes that reduce risk are explored further on the ‘Hierarchy of controls’ section.

PRIMO is a cyclical process that should be repeated. Once changes have been implemented, these stages should be repeated and the mean scores on the questionnaire recalculated to identify whether changes are having an impact. It may be helpful to plot the mean scores on a graph to visualise the improvement and share this with the team. This process can form the basis of a PDSA cycle, more information on which can be found in the PDSA section.