Safety Improvement Projects
The Canadian Patient Safety Institute is working with committed partners to implement and evaluate measurable and sustainable safety improvement projects that align with pan Canadian priorities. In October 2018, 30 teams from across Canada joined one of four 18-month learning collaboratives focused on the Measurement and Monitoring of Safety, Medication Safety at Care Transitions, Teamwork and Communication and Enhanced Recovery Canada. Teams participating in the Safety Improvement Projects are currently in the sustainability, measurement and spread phase; and teams continue to report data. The emergence of COVID-19 has delayed completion of an evaluation of the Safety Improvement Projects and the Closing Congress scheduled for March 2020 is being rescheduled.
During 2019-2020, a Learning Management System (LMS) was implemented with courses to support participants in each Safety Improvement Project. Interactive tools and resources were developed to support learning in the new LMS. Since its launch in April 2019, 225 user accounts have been created, with almost 20,000 activities and more than 1,800 posts recorded. A data collection database was launched in May 2019, with 100 user accounts created and measures for 103 data collection instruments.
A Guide to Patient Safety Improvement: Knowledge Translation & Quality Improvement Integrated Approach was developed to support implementation, and project management capacity-building activities were a focus of group training sessions and individual coaching.
Enhanced Recovery Canada
A key deliverable of the Enhanced Recovery Canada (ERC) program has seven teams from across the country participating in an 18-month ERC Safety Improvement Project. The teams have been working diligently to implement 17 process and four outcome-related evidence-based measures. Although in the early stages of data submission, most teams are reporting significant improvements.
Operations were put in place to support the development of Enhanced Recovery processes for both providers and patients for two additional surgery types, gynecologic and orthopedic (total hip and total knee arthroplasty).
Measuring and Monitoring of Safety
Since the Fall of 2018, 11 teams from seven provinces across Canada have been participating in an 18-month learning collaborative to develop a more comprehensive approach to safety and the delivery of safer care. The Canadian Patient Safety Institute partnered with the University of Toronto to provide expert faculty and mentorship to enable the implementation of the Measurement and Monitoring of Safety Framework (MMSF) to provide a new conceptual way of thinking and acting to promote patient safety. The Framework is based on five dimensions to facilitate a deeper reflection on safety: past harm, reliability, sensitivity to operations, anticipation and preparedness, and integration and learning.
In 2019-2020, point-of-care teams and leaders participated in four in-person learning sessions, three on-site coaching visits, monthly coaching calls and monthly educational webinar sessions. Team videos were created to demonstrate the power of the learning collaborative experience.
To evaluate the impact, primary measures of success were measured using the MMSF Maturity Matrix; all 11 teams showed improvement. A secondary measure used was a modified self-assessment tool, where teams assessed their progress in implementing patient safety initiatives. Two patient engagement measures were also examined using an International Association for Public Participation (IAP2) tool and actual engagement of clients. Teams were encouraged to find ways to engage clients without being prescriptive. All teams rated high in their IAP2 scores, but levels of patient engagement varied between teams. Dr. G. Ross Baker and a team of researchers from the University of Toronto led an independent evaluation of the learning collaborative. Findings of the report were encouraging, touting the benefit of the MMSF in increasing the focus of patient safety among participating teams.
Five teams from across the country are participating in the Medication Safety SIP, learning from clinical experts and academics on evidence-based processes for improving medication reviews, dispensing processes, deprescribing, and care of frail elderly. Monthly learning sessions, coaching calls and at least one site visit were conducted during the past year to support and elevate best practices, and to gain a clear understanding of the barriers and facilitators related to implementation. A rigorous evaluation process was implemented to ensure evidence can be used to bridge gaps that currently exist and ultimately improve patient safety outcomes in Canada.
The teams are addressing key deliverables to support the World Health Organization’s (WHO) Third Global Patient Safety Challenge: Medication Without Harm, including: polypharmacy, transitions in care, and using empowerment to drive practice change, including use of the 5 Questions to Ask tool.
Teamwork and Communication
The seven teams participating in the Teamwork and Communication Safety Improvement Project have participated in seven learning sessions, monthly coaching calls and onsite visits focused on a knowledge translation/quality improvement integrated approach and delivery of the Canadian Patient Safety Institute’s TeamSTEPPS Canada™ program. The Safety Improvement Project teams have completed a newly created Micro-Learning Essentials course that focuses on accessibility, interactivity, and relevance; and in partnership with the Health Quality Council of Alberta, teams are being trained as Canadian Patient Safety Institute TeamSTEPPS Canada™ Master Trainers.
Teams have shared their implementation plans on the learning platform and both collect and submit data for organizational-level performance measures for their safety improvement projects.
Atlantic Health Quality and Patient Safety Collaborative on Patient Engagement
This 12-month program used a quality improvement, patient engagement, and patient safety methodology to deliver a virtual collaborative on patient engagement. Participating teams tested ideas and shared learnings with each other. Some examples of the patient engagement practices implemented include: a regional emergency policy to support family presence during resuscitation; creation of a Patient and Family Advisory Council that includes diversity based on geography, age, gender, background and healthcare experience that patients and families bring to their role as Patient Experience Advisors; and collaboration between staff and Patient and Family Advisory Council members to implement bedside handover. The Engaging Patients in Patient Safety: A Canadian Guide was used to support the work of the collaborative.
A review of the Canadian Patient Safety Institute’s education programs resulted in the development of a new capability-building model that strengthens our role as an expert in patient safety, rather than as a delivery agent. Our design and development of initiatives that strengthen a commitment to patient safety and demonstrating what works is based on bolstering or building relationships with provincial/territorial Ministries of Health, regulatory bodies, and education partners.
ASPIRE – Advancing Safety for Patients in Residency Education
In collaboration with the Royal College, the Advancing Safety for Patients in Residency Education (ASPIRE) certificate course was delivered to 48 residents in Ottawa in May 2019. This intense four-day workshop is dedicated to enhancing the capacity of Canadian medical schools to provide patient safety training.
Highlights of the 2019 program included Dr. Amir Ginzburg’s innovative approach to underline the importance of teamwork and communication to advance safety for patients in residency education; and Dr. George Mastoras and the simulation team from The Ottawa Hospital Emergency Department illustration of how simulation can be used to identify latent risk factors in patient safety and the value of teamwork and communication during stressful clinical events, such as cardiac arrest.
Canadian Patient Safety Officer Course
The Canadian Patient Safety Institute and HealthCareCAN jointly delivered the Canadian Patient Safety Officer Course to 35 participants in June 2019, at a four-day in-person session in Ottawa, Ontario. On completion of the course, course graduates can affect the system change required to advance patient safety in their organization. An online version of the course is available for learners who want the flexibility to learn at their own pace.
In partnership with Indigenous Services Canada, an incident management training program was customized and delivered to 70 Indigenous Services Canada frontline managers and providers, to build self-capacity for incident management training and education within the organization. Included in this training were three Incident Management Training in-person skills building workshops that were offered in Alberta, Manitoba and Ontario over the course of three months. A report on Incident Management and Reporting in Healthcare: A Pan-Canadian Perspective, published in an issue of Healthcare Quarterly, was disseminated at the Canadian Association for Health Services and Policy Research conference in 2019.
Effective Governance for Quality and Patient Safety
The Effective Governance for Quality and Patient Safety program offers a unique opportunity to develop evidence-informed approaches to governance and leadership and to share innovative health governance practices, resources and tools. Training was delivered to a total of 133 participants at four sessions held in Newfoundland in the Spring 2019 and one session in the Northwest Territories in the Fall 2019.
Protecting Canadians from Unsafe Drugs Act
The Protecting Canadians from Unsafe Drugs Act, also known as Vanessa's Law, introduced regulations that require mandatory reporting of serious Adverse Drug Reactions (ADR) and Medical Device Incidents (MDI) by hospitals, effective December 16, 2019. In a joint venture, the Canadian Patient Safety Institute, the Institute for Safe Medication Practices Canada (ISMP Canada) and Health Standards Organization, in collaboration with Health Canada, created educational resources to support and raise awareness of the mandatory reporting requirements. Four modules provide an overview of Vanessa's Law and Reporting Requirements, Reporting Processes to Health Canada, Strategies to Promote and Support Mandatory Reporting, and Health Canada's Review and Communication of Safety Findings. Patients for Patient Safety Canada also helped to create a patient module. PowerPoint slides designed as "building blocks" were created for integration into learning programs and other educational activities.
In collaboration with Patients for Patient Safety Canada, the Canadian Patient Safety Institute engaged in a comprehensive and robust process to revise and update the first edition of the Safety Competencies Framework. The revisions included over 60 volunteers serving as members of a Steering Committee, content experts, Domain Working Groups, and external reviewers to produce a second edition, the 2020 Safety Competencies Framework. The revisions were informed and validated through a safety education survey and modified Delphi process. The second edition will be released in 2020.
The Canadian Patient Safety Institute is working with Simulation Canada to develop a patient safety simulation curriculum. In May 2019, the Canadian Patient Safety Institute, the Health Insurance Reciprocal of Canada (HIROC), and Vancouver Coastal Health collaborated with Simulation Canada to offer a one-day National Forum on Simulation for Quality and Patient Safety that highlighted the many roles simulation plays to advance patient safety and quality at the point of care delivery and celebrated achievements in Canada.
The Canadian Patient Safety Institute is proudly designated by AHRQ and the American Hospital Association as the National Coordinating Centre for TeamSTEPPS Canada™.
An open-access e-learning course, TeamSTEPPS Essentials was designed in both official languages. The course will be launched in 2020. Simulation videos to support the new course were designed and filmed at the University of Ottawa Centre for Innovative Education and Simulation in Nursing. The videos demonstrate TeamSTEPPS communication tools that have been embedded into the Essentials open access micro-learning course, along with additional teamwork and communication videos and infographics that can be used to support e-learning courses. Tools and concepts learned in the TeamSTEPPS Canada™ program are applicable to all healthcare leaders, administrators, providers and patients and families in any healthcare setting.
Capability Building / International
The Canadian Patient Safety Institute was asked to contribute to two international initiatives that will inform patient safety education globally and to explore ways of improving the measurement of patient safety.
WHO Patient Safety Curricula Expert Advisory
As a WHO Collaborating Centre, the Canadian Patient Safety Institute was requested to join the International Patient Safety Curriculum Working Group together with multiple global experts. We will contribute to and collaborate with WHO and Imperial College London as an Editorial Board Member and author for the revisions to the WHO Patient Safety Curriculum Guide: Multi-professional Edition. An initial meeting was held in London to launch this important work that would inform patient safety education globally. The Canadian Patient Safety Institute is contributing to:
- Patient and Family Engagement
- Legal and Regulatory Frameworks
- Understanding and Dealing with System Complexity and Multiplicity of Factor
- Safety Culture and Just Culture
- Effective Communication
- Patient Safety Incident Management (Canadian Patient Safety Institute authored)
- Medical Device Safety (Canadian Patient Safety Institute co-authored)
Knowledge to Action
The Canadian Patient Safety Institute has prioritized knowledge translation as one of the key mechanisms through which organizational strategic goals will be accomplished. Synergies between knowledge translation and quality improvement that will provide the greatest impact in patient safety have been identified.
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, patients, healthcare leaders and providers.
In 2019-2020 there were eight #SHIFTtalks blog posts and 10 innovative profiles (#SuperSHIFTERS) posted to the SHIFT to Safety webpage to promote awareness of patient safety issues and initiatives for improvement within healthcare. In total, 7,153 page views of the articles were garnered; 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, Patients for Patient Safety Canada, and HIROC to provide the public, providers and leaders access to various tools and resources to support early recognition of clinical deterioration. To help build capacity, international, and national resources have been curated and are freely available on the Canadian Patient Safety Institute’s website. These resources were recently updated through a grey/white literature review.
With support from an expert panel, resources have been drafted to support parents and caregivers with early recognition of clinical deterioration in children. “Signs for Kids” is currently being validated before broad distribution to the public.
Leading Change Toolkit
The Registered Nurses’ Association of Ontario (RNAO) and the Canadian Patient Safety Institute have partnered to develop a Leading Change Toolkit. It is being created for champions and change teams who work across all health sectors in Canada and internationally with identified goals to promote healthcare excellence at the point-of-care, and to create sustainable evidence-based cultures. The project team has been working together with an expert panel that is made up of national and international experts, including interprofessional healthcare providers from numerous sectors, patients and families with lived-experience, and those with expertise in knowledge translation, implementation science, social movement thinking, quality improvement and best practice guideline implementation. The Leading Change Toolkit will include two main frameworks: the Knowledge to Action Framework, and a new Social Movement Action Framework. The expected date of completion of the Toolkit is November 2020.
Research, Evaluation and Intelligence Gathering
Research commissioned by the Canadian Patient Safety Institute in 2019-2020 included an independent evaluation of the Safety improvement Projects, conducted by Dr. G. Ross Baker and a team of researchers from the University of Toronto; a deep dive into the Measuring and Monitoring of Safety Framework using the MMSF Maturity Matrix; and a study looking at the MMSF through the eyes of the patient led by Dr. Lianne Jeffs. A review of educational services offered by the Canadian Patient Safety Institute was completed by the Lough Barnes Consulting Group. Letters of support were provided to seven external researchers seeking grant funding for activities that support our patient safety goals.