Safety Improvement Projects
The Canadian Patient Safety Institute launched four new Safety Improvement Projects guided by a unique quality improvement/knowledge translation implementation science model for accelerating patient safety in Canada. This integrated learning design will provide a significant positive impact on patient safety outcomes; spread knowledge translation approaches across the healthcare system; and advance the use of evidence in healthcare. Each Safety Improvement Project lasts 18 months and uses principles from the Institute for Healthcare Improvement Breakthrough Series and the Knowledge to Action Framework. The participating teams will report on their work at a closing congress in April 2020.
This is an example of a strategic direction aimed at working with multiple healthcare system partners to demonstrate what works. The Safety Improvement Projects are designed to provide system and provider implementation support and to evaluate how organizational readiness for change will contribute to the evidence required to improve and sustain and improve patient safety within our healthcare system, with the goal of strengthening the system’s commitment.
Working with committed partners, we will implement and evaluate these measurable and sustainable Safety Improvement Projects that align with pan-Canadian priorities:
Measurement and Monitoring of Safety: creating a culture of safety and reducing harm in your organization.
Enhanced Recovery Canada: leading to improved outcomes and system efficiencies for colorectal surgery patients.
Medication Safety at Care Transitions: improving medication safety at discharge for frail, elderly patients with poly-morbidity in your organization.
Teamwork and Communication: leading to improved patient safety culture and positive patient outcomes.
Coaching for the new Safety Improvement Project teams and site visits across the country are underway. Change packages will support implementation, and members of our patient-led program, Patients for Patient Safety Canada, are actively involved throughout the entire project lifecycle to guide the design of the patient engagement content and delivery.
The Evaluation Framework for the Safety Improvement Projects is being led by Dr. Lianne Jeffs. REDCap has been sourced for measurement of the impact of the Safety Improvement Projects. Project specific measures and outcome and process measures are being developed so that teams can begin baseline data entry. The measures will inform the Canadian Patient Safety Institute’s Performance Measurement Strategy and Safety Improvement Plan Evaluation Framework.
Measuring and Monitoring of Safety: The Measuring and Monitoring of Safety Framework, created by Professor Charles Vincent and colleagues from the Health Foundation in the United Kingdom, consists of five domains that prompt a series of key questions to help you to rethink your understanding of safety in your own clinical environment. The Framework provides a broader view of the information needed to create and sustain safer care. The primary questions to be answered by patients, providers and leaders are: Has care been safe in the past? Are our clinical systems and processes reliable? Is care safe today? Will care be safe in the future? Are we responding and improving?
The Measuring and Monitoring of Safety (MMS) Framework represents an exciting new approach to how organizations conceptualize safety and their attention to creating a broader view of safety. A 12-month demonstration project, which ran in collaboration with the University of Toronto, concluded in April 2018. During the demonstration project eight teams from seven healthcare organizations across the country participated in a two-phase, two-day learning session followed by a six-month action period. The demonstration project wrapped up with a one day closing congress, followed by a CEO forum to share key learnings. The objective of the demonstration project was to examine the relevance of the MMS framework in the Canadian context.
Building on the success of the demonstration project, 11 teams are now participating in the MMS safety improvement project to rewire their thinking on patient safety and work within their organizations to foster and promote a new approach to safety.
Enhanced Recovery Canada: Evidence supports that when Enhanced Recovery best practices are applied; the result is shorter lengths of stay and decreased complication rates for patients. While pockets of implementation have been identified across the country, these best practices have not yet been widely adopted. Supported by a governance group and close to 30 national partners, the Canadian Patient Safety Institute Enhanced Recovery Canada™ (ERC) project has made steady progress supporting broader implementation.
Supporting the core pillars of Enhanced Recovery, six patient engagement and interdisciplinary working groups were developed to review, adopt and or adapt the evidence to meet the Canadian context.
In addition to targeted dissemination strategies, Enhanced Recovery Canada’s primary efforts focused on the development of clinical pathway and patient engagement resources for colorectal surgeries. These resources will be made freely available on the Canadian Patient Safety Institute website and are being launched formally as part of the Enhanced Recovery Canada™ Safety Improvement Project implementation strategy. Using a knowledge translation/quality improvement framework, seven teams from across the country will be supported in implementing ERC best practices through a collaborative starting in April 2019.
The Safety Improvement Project will include an extensive evaluation of both clinical and system impacts.
Medication Safety at Care Transitions: The Medication Safety for Care Transitions safety improvement project has incorporated these actions into the program design. The Safety Improvement Project will also highlight best practices around assessing frail patients and reviewing, de-prescribing / right-prescribing for this population; and changing how medications are dispensed for this vulnerable population. Five teams from across the country are enrolled in the Safety Improvement Project.
The Canadian Patient Safety Institute connected with various partner agencies, such as the Canadian Frailty Network, Canadian Deprescribing Network, and Choosing Wisely Canada. As well, the knowledge and experience of clinical experts from Mount Sinai, Grand River and Winchester District Memorial hospitals is being leveraged to demonstrate and spread evidence based practices that make medication use safer, and reduce emergency room visits, and readmissions among Canadians with polypharmacy.
Teamwork and Communication: Over the past 10 years, we learned that providing evidenced based practices to healthcare teams is not enough to improve patient safety. Instead, there needs to be a shift, with a focus on how to improve skills such as communication and teamwork, thereby improving patient safety culture and patient outcomes. By focusing on improving teamwork, communication and patient safety culture, we will truly raise the patient safety bar.
The Teamwork and Communication safety improvement project was launched where teams will learn how to actively solve local level teamwork and communication issues that are impacting patient safety outcomes. The seven teams from across the country participating in the Teamwork and Communication Safety Improvement Project are being provided with TeamSTEPPS Canada™ Master training.
The Canadian Patient Safety Institute’s suite of educational and training programs and knowledge products continue to be well-sought after both nationally and internationally. The programs offered include ASPIRE, the Canadian Patient Safety Officer Course, Effective Governance for Patient Safety, Patient Safety Education Program – Canada, Disclosure and Incident Management and TeamSTEPPS Canada™. The programming engages a diverse healthcare audience and is effective for multiple stakeholders (frontline to boards and CEO’s). The capability building strategy works hand-in-hand with partners, associations and academic institutions to embed patient safety competencies into health professional curriculum.
The Canadian Patient Safety Institute has engaged a consultant to conduct a review of its education programs, which will result in a new capability-building model that will be aligned with the organization’s strategic plan. The evaluation will be completed by the Fall 2019.
ASPIRE – Advancing Safety for Patients in Residency Education: ASPIRE educational sessions are delivered by well-respected, quality and patient safety healthcare professionals and educators from across Canada. This program is geared towards medical educators and residents with a keen interest in teaching and implementing patient safety and quality improvement initiatives in their practice.
The ASPIRE Essentials one-day training session was delivered to 35 residents at the International Conference on Residency Education in Halifax, in October 2018. Planning is underway to deliver two Essential courses in French in 2019. In addition, an ASPIRE 2019 workshop will be held in Ottawa, May 28-31, 2019.
Canadian Association of Schools of Nursing: The Canadian Patient Safety Institute and the Canadian Association of Schools of Nursing (CASN) partnered to develop national learning outcomes for graduates of baccalaureate programs of nursing. The aim in is to highlight leading practices in this area as they relate specifically to entry-level nursing. This work provides the foundation for graduating registered nurses to integrate the Safety Competencies.
To support the dissemination of CASN's revised 2018-2019 National Nursing Education Framework, the Learning Outcomes for Patient Safety in Undergraduate Nursing Curricula resource was posted on both the Canadian Patient Safety Institute and CASN websites.
Canadian Patient Safety Officer Course: The Canadian Patient Safety Officer Course (CPSOC) brings clinicians and leaders from across Canada and around the world together for an intensive learning program delivered by the most influential leaders in patient safety. This program combines knowledge translation, human factors, second victim, cognitive load, and quality improvement into a four-day course which equips participants to develop a deep understanding of patient safety and how to develop and implement safer practices at their home organization. This program teaches best practices in disclosure, sustainability, human factors, and communication in order to strengthen participant’s commitment to improvement. The CPSOC was delivered in June 2018, with 44 participants.
During the 2018-2019 fiscal year, the format of the CPSOC was revised to make it more interactive and enable teams to better implement what they have learned. Knowledge translation was also added as a key foundation of the content design.
Disclosure and Incident Management: A report entitled, Incident Management Training Needs was produced by Ryerson University based on findings of a needs assessment of Canadian Patient Safety Institute stakeholders. The report is now under peer review and is expected to be published in the Fall 2019.
The results of the study highlight the importance of promoting stakeholder involvement across sectors and provinces in order to improve patient safety through enhanced awareness, education and prevention.
Incident Management Training for Indigenous Services Canada: An agreement has been signed with Indigenous Services Canada (ISC) for the provision of incident management training for ISC nurse managers and frontline providers working in communities across Canada.
Effective Governance for Quality and Patient Safety: The Effective Governance for Quality and Patient Safety program offers the opportunity to learn from peers, develop evidence-informed approaches to governance and leadership and to share innovative healthcare governance practices, resources and tools. The purpose of the program is to offer governors and organizational leaders the opportunity to learn evidence-informed practices for effective governance and leadership.
The Canadian Patient Safety Institute worked with its HUB partner the Ontario Hospital Association to review the objectives and content of the modules for the Effective Governance program. A renewed session was delivered to 42 participants in March 2019.
Safety Competencies: Together with the Royal College of Physicians and Surgeons of Canada and a vast network of health professionals and leaders, the Canadian Patient Safety Institute developed a Safety Competencies Framework in 2008 and revised it in 2009 to identify the knowledge, skills, and attitudes required by all healthcare professionals to provide safe care.
In April 2018, 61 stakeholders from across Canada were brought together to revise and update the Safety Competencies Framework. The Steering Committee, content experts, domain working groups, advisors and consultants worked from April to November 2018 to update the Safety Competencies to reflect current practices and curricula in patient safety and reduce unnecessary redundancies, and simplify to facilitate usability. A modified Delphi process is now underway to gain a further perspective from additional subject matter experts from across Canada. This work will be completed in the 2019-2020 fiscal year.
The updated Safety Competencies will be integrated into pre-professional education by post-secondary educational institutions and post-professional training by healthcare organizations.
TeamSTEPPS Canada: In early 2018, the Canadian Patient Safety Institute received exclusive Canadian licencing rights to adapt TeamSTEPPS® (a ‘train-the-trainer’ communication and teamwork development program) to a new and revised TeamSTEPPS Canada™ program. The updated program includes Canadian content consisting of videos and teaching aids, data sources, and references; enhanced patient-focused content developed in partnership with the Canadian Patient Safety Institute’s patient-led program, Patients for Patient Safety Canada; inclusion and representation of multiple health sectors; use of simulation and game play throughout content delivery; and support and connection to provide a TeamSTEPPS Canada community.
The Canadian Patient Safety Institute offered three TeamSTEPPS Canada Master Trainer sessions in 2018-2019. In partnership with the Health Quality Council of Alberta (HQCA), three additional TeamSTEPPS Canada Master Trainer sessions were held, one in Calgary and two in Edmonton. A total of 143 participants were trained as TeamSTEPPS Canada Master Trainers in 2018-2019.
Over the next year, the Canadian Patient Safety Institute will continue to promote TeamSTEPPS awareness by presenting at a conference, providing training and begin offering the TeamSTEPPS Canada™ fundamental content on the Canadian Patient Safety Institute’s SHIFT to Safety website. We will also engage with health quality councils and various stakeholders to explore a fit for becoming a regional training centre, as demonstrated by Health Quality Council of Alberta pilot.
A third-party external organization was engaged to measure the TeamSTEPPS Canada™ curriculum, delivery and impact of implementation to the Canadian health system. The evaluation, conducted by The Spindle Strategy for the Life Sciences, revealed that the program is on a long-term path to achieve organizational and patient-level improvements in safety and care.
Protecting Canadians from Unsafe Drugs Act: The Canadian Patient Safety Institute supports the implementation of the Protecting Canadians from Unsafe Drugs Act (also referred to as Vanessa's Law). Under the Protecting Canadians from Unsafe Drugs Act, reporting will provide Health Canada with more safety information on drugs and medical devices and improve their ability to act on that information. Consumers will benefit from this law in many ways:
- Health Canada can remove unsafe drugs and medical devices from the Canadian market.
- Health Canada can require manufacturers to make changes to health product labels or packages to make safety information more available to consumers.
- More reporting can improve products and health outcomes for all Canadians.
The Canadian Patient Safety Institute, the HSO and ISMP Canada have partnered to develop and implement an educational approach and content to support healthcare professionals and healthcare institutions in the identification and reporting of serious adverse drug reactions (ADR) and medical device incidents (MDI). This includes an assessment of the type of outreach, education and feedback needed to motivate and support ADR and MDI reporting.
Five educational modules for healthcare providers have been developed, to be hosted on the Canadian Patient Safety Institute website starting in July 2019. A pilot testing of the educational modules conducted in March 2019 was completed by 255 unique respondents, including individuals and organizations from across Canada.
Canadian Human Factors in Healthcare Network: SHIFT to Safety partnered with the Canadian Human Factors in Healthcare Network to showcase the latest advancements in human factors in healthcare. A nine-part human factors education series aimed at improving the human factors knowledge for healthcare providers and leaders is available on the website as video on-demand. Four webinar calls were held in 2018-2019, with 396 attendees representing the healthcare sector across Canada.
SHIFT to Safety: SHIFT to Safety is the Canadian Patient Safety Institute’s key knowledge translation platform. SHIFT to Safety continues to accelerate capability building through various knowledge translation activities designed for the public and patients, healthcare leaders, and healthcare providers.
SHIFT to Safety partnered with Dr. Jeremy Grimshaw from the Ottawa Hospital Research Institute to offer a six-part knowledge translation and implementation science webinar education series. In 2018-2019, 556 attendees participating in these calls where knowledge translation science was shared through research, national expert guest speakers and local level experiences of successful change.
To promote awareness of patient safety issues and initiatives for improvement within healthcare, nine blog posts (#SHIFTtalks) and nine innovative interviews (#SuperSHIFTERS) were posted to the SHIFT to Safety webpage last year. In total, there were 7,046 page views of the articles in 2018-2019, an average of 20 page views per day.
Deteriorating Patient Condition: The Deteriorating Patient Condition initiative is a partnership between the Canadian Patient Safety Institute and its patient-led program Patients for Patient Safety Canada, and the Health Insurance Reciprocal of Canada (HIROC). The work focuses on providing the public, leaders and providers with access to various tools and resources to support early recognition of clinical deterioration. International and national resources are being curated to help build capacity.
One of the highlights in 2018-2019 was the launch of a designed for the public to help recognize early signs of clinical deterioration. A successful social media campaign was implemented to promote the video and affect behavioural change; the video was viewed 1,585 times last year.
An expert panel was convened in May 2018 to develop “Signs for Kids” resources to support the early recognition of clinical deterioration in children. These resources are now being validated at several pediatric care centers prior to broad distribution to the public. This work on the deteriorating patient condition and the Signs for Kids pediatric resource was selected for a panel presentation at the Institute for Healthcare Improvement (IHI) / BMJ Quality Forum held in Glasgow, Scotland in March 2019.
Additionally, and with support from the Society of Obstetricians and Gynaecologists of Canada, a national webinar regarding maternal mortality was hosted in February 2019, with 89 registrants participating in the call.
In the coming year, the resources supporting the early recognition of clinical deterioration will be updated as indicated through a grey/white literature review.
Patient Safety Culture Bundle: The Patient Safety Culture "Bundle" for CEOs and Senior Leaders is based on a set of evidence-based practices that must all be applied in order to deliver good care, and it recognizes that improving safety requires an organizational culture that enables and prioritizes patient safety. Strengthening a safety culture necessitates the interventions outlined within the Bundle that simultaneously enable, enact and elaborate in a way that is attuned to the existing culture.
The Bundle was completed in June 2018 and presented at the National Health Leadership Conference in St. John’s, Newfoundland, as well as at numerous regional, national and international conferences/forums throughout the year. Work continues to develop live links to each component of the Bundle.
View the one-pager of the Patient Safety Culture Bundle for CEOs and Leaders
Research: The Canadian Patient Safety Institute has commissioned Dr. Lianne Jeffs to conduct a research study which aims to “strengthen and spread a new approach to patient safety that is grounded in the five dimensions of the Measurement and Monitoring of Safety Framework and includes the voice of patients, families and carers”. The research will include a mixed methods approach that involves:
- Synthesis of Measurement and Monitoring of Safety Framework and Literature summary
- Qualitative Inquiry and Data Analysis
- Developing Patient Reported Experience Measures (PREMs)/Patient Reported Outcome Measures (PROMs)
- Knowledge Translation/Evidence Informed Solutions
The final report will be published in the Spring of 2020.
Simulation: Simulation is revolutionizing approaches to patient safety and quality improvement in healthcare. The Canadian Patient Safety Institute is working with SimONE and CAE to develop a Memorandum of Understanding (MOU) that will incorporate and advance patient safety themes in simulation activities and practices across Canada. Working with industry and simulation experts we are demonstrating what works, as patient safety is a key output of simulation, and by sharing evidence of the impact of simulation on the healthcare system in terms of return on investment.
In 2019-2020, the Canadian Patient Safety Institute will collaborate with Sim-ONE to support simulation education as a method to improve patient safety, including the development of TeamSTEPPS Canada™ curriculum. We are also partnering with SimONE and CAE on the co-development of an on-line educational patient safety module that uses principles of simulation.