Hospital Harm in Canada — Kate Parson, Linda Silas, Kathleen Finlay and Annette Elliott Rose

Avis Favaro

When you go to a hospital for treatment, there’s an expectation that you’ll be kept safe. But new data from the Canadian Institute for Health Information finds that since the pandemic, the rate of unintended harms to patients have gone up.

Kate Parson

For the third year in a row, we’ve seen an increase in overall harms in the hospital.

Avis Favaro

That includes new infections, bed sores, medication errors. The data also shows that health care staff is struggling, with nurses clocking in some 14 million overtime hours, leaving exhausted staff fearing patient errors.

Linda Silas

Why does a pilot have so many hours in a week, in a month, that he or she can do because of the security of the passengers? Or a truck driver? Or a bus driver? But in nursing, there’s no limit. We have precious cargo too, and it’s our patients.

Avis Favaro

There’s an emotional and physical cost to patients and their families, like that of Kathleen Finlay, who says hospital mistakes shortened the life of her mother.

Kathleen Finlay

I don’t think this is about blame. I think it’s about protecting patients.

Avis Favaro

Welcome to the Canadian Health Information Podcast. We call it the CHIP for short. I’m Avis Favaro, the host of this conversation.

One note, the opinions expressed here don’t necessarily reflect those of CIHI, but it’s a free and open discussion. And this episode is about patient safety and what we can learn from the numbers to help keep hospitals as safe as possible for patients.

Our first guest today is Kate Parson. Welcome, Kate.

Kate Parson

Thank you for having me, Avis.

Avis Favaro

And you’re the woman behind the data that we’re going to be talking about because you’re the program lead on the Health Human Resources Team at CIHI.

Kate Parson

Yes. Me and a team of others here are behind this report.

Avis Favaro

So when we talk about hospital harm, I think people cringe because we don’t want to hear about hospital harm.

Kate Parson

Yes. We know it’s not a nice topic to talk about. But in order to manage and hopefully prevent these things, we need to to be able to measure it.

Avis Favaro

If you can’t see it and you can’t measure it, you can’t fix it.

Kate Parson

Exactly.

Avis Favaro

So when did you start tracking this? How long ago did CIHI start measuring hospital harm?

Kate Parson

CIHI has been tracking this since 2014.

Avis Favaro

And how do you do that? Is this something hospitals must report?

Kate Parson

So specific diagnoses get tracked in patients’ charts by a number of providers that provide them care. And harms are counted as things that a patient didn’t have when they arrived at the hospital and then went on to develop. And it’s specific diagnoses like pressure ulcers, urinary tract infections that get couched as part of this harm metric. And yes, hospitals are required to report it.

Avis Favaro

Why don’t we take a look at overall, what were the key findings in this report?

Kate Parson

So the fact that hospital harm had been actually stable for a number of years overall and for the third year in a row, the rate has gone up, I feel like is quite striking. Prior to 2020, the rate had been stable since 2014. And for the third year in a row, we’ve seen an increase in overall harms in the hospital.

Avis Favaro

So, and this would be linked to the pandemic.

Kate Parson

Yes. So when we’re looking at these specific categories of harms that are generally associated with staff, we saw that during the pandemic, when compared to the pre-pandemic period, that urinary tract infections and pneumonia increased by about 20%; aspiration pneumonia, which is a specific type of pneumonia caused by inhaling water or food, increased by about 25%; and pressure ulcers increased by over 50. Though with this number, this may be in part due to better data capture last year on 22–23.

Avis Favaro

Those are all big increases. Were you surprised?

Kate Parson

When you look at the raw numbers, they are still very small, sort of less than one in a hundred. But yes. The increase is worth taking note of.

Avis Favaro

So one of the common things in the harms that you’ve measured is a link with staffing. If patients are turned regularly, bed sores are less common. If they’re fed sitting up slowly, they’re less likely to develop pneumonia from inhaling.

So in this report, you did something different. You looked at the harm along with staffing levels. So I believe you counted sick days, overtime and the use of freelance or agency nurses. What did you find, Kate?

Kate Parson

Over the course of the pandemic across Canada, we know there’ve been a number of staffing challenges in hospitals. And we’ve been able to monitor a few different things like sick time, overtime, use of agency staff within hospital nursing patient units. And we’ve seen these types of staffing indicators increase dramatically.

To give you a bit of an example, we saw on inpatient units, so people working within the units, nurses and other health care providers, they logged an increase of 17% of sick time year over year and a 50% increase in overtime hours worked.

Avis Favaro

Were the increases significant and noteworthy?

Kate Parson

Yes. They’ve increased significantly over the past 5 years, but the last year we looked at was even greater. To give you an example, agency staff use, so the use of purchased hours from employees not employed by the hospital, which I know we’ve heard a lot about recently, they increased by 80%.

Avis Favaro

Eighty. Eight-zero.

Kate Parson

Eight-zero. While overall, purchased hours are still a small percentage of the overall hours worked, the 80% increase is obviously notable.

Avis Favaro

Was there any time in the prior years going back to when you started doing this in 2014 that you saw staffing levels like what you saw in the most recent study?

Kate Parson

So with the staffing levels, we’ve been putting that out for the last few years for separate to hospital harm. But no. This is the highest we’ve ever seen.

And the thing that I find the most notable is when we look at the staffing numbers in the sense of full-time equivalents, so kind of a special measure to be able to add up staff hours and think of them as full-time employees, and that when you look at the sick time all in all, it actually translates to a shortfall of around 6,000 employees across the country. And when you add up the overtime hours, it actually equates to more than 7,000 workers.

Avis Favaro

What does that mean? Can you explain that?

Kate Parson

With overtime specifically, that if a worker works a standard full-time job, the overtime hours worked — so they’re the people that are already working, assumingly, their full-time job — they’re working the equivalent of 7,000 more jobs across the country for the year 2020–2021. But it basically equates to people are working above and beyond. They’re working like 2 people, 3 people in some instances.

Avis Favaro

Okay. And the interpretation of that is?

Kate Parson

That, unfortunately, we don’t have enough staff to meet the needs of the system currently and we’re relying heavily on people to do overtime or agency staff to fill the gaps. We’re really looking at triangulating a few different topics which we know are of public interest and interest to decision-makers around sort of understanding staff well-being and how it’s very closely linked to patient safety and care.

Avis Favaro

So how important do you think these numbers are going to be for people in decision-making positions at hospitals?

Kate Parson

I think it’s going to be very important that the hospital has access to their numbers and, particularly, the trends year over year, because every hospital is obviously different. But understanding their own individual change year over year is important to help manage these harms.

Avis Favaro

Now, patients listening to this might feel concerned because people go to hospital to get better. People go for treatments, and the expectation is that they will come out the same or better when they go.

How do you want the public to interpret this data?

Kate Parson

I think that everyone should be aware and transparent about this data and understand it, but know, ultimately, that efforts are underway across the country to provide patients the best available care to them. And that includes tracking things like this in order to prevent them.

Avis Favaro

Is it pointing to the fact that perhaps some of the increase in hospital harm could be reduced by having better staffing levels?

Kate Parson

So we can’t say anything definitively. But we do know from what we’re hearing that when there is appropriate staffing levels, staff feel supported at work, they don’t feel burnt out, that they are obviously able to do their job in a way that they — to the best of their ability, where they have people they can rely on, team members, they can ask questions to, they aren’t exhausted, et cetera.

Avis Favaro

This seems to me to be a very important message from this CIHI report.

Kate Parson

Yes. This, we hope, is a conversation starter and sort of the first to look at this, we know, challenging and troubling subject area. But in order to drive improvements and support staff and ultimately improve patient care, we think it warrants exploration and ongoing monitoring.

Avis Favaro

Okay. Kate, thank you so much for being on the podcast.

Kate Parson

Thank you for having me, Avis.

Avis Favaro

Our next guest can talk about the new data and what it means from ground level. We welcome Registered Nurse Elliott-Rose from Halifax. Hi, .

Elliott-Rose

Hi, Avis. How are you?

Avis Favaro

Good. You have a number of other roles or job titles, including Chief Nurse Executive and VP of Clinical Care at IWK in Nova Scotia. Is that correct?

Elliott-Rose

That’s correct. Yeah. I’m currently working on strategy with the IWK and also doing some work with the province and system partners on health workforce.

Avis Favaro

And so what does that mean you do in terms of hospital safety, harms, and staffing?

Elliott-Rose

I would work directly with the teams on the ground and with the executive team to ensure that we have the best approach to quality and safety at the IWK. I mean, if I can use the IWK as an example, we belong to an international collaborative called Solutions for Patient Safety.

Avis Favaro

Yeah. And that’s what our topic is about today on the podcast. So you’ve heard of the latest CIHI data in terms of hospital harms. Let’s start with that.

When you heard about the rate of harms and that they’ve basically stayed higher than they were before the pandemic and in fact show some signs of increasing, what was your first reaction?

Elliott-Rose

I think that any trend where safety has changed is something for us to be concerned of, whether there’s a pandemic or not. I think there were a lot of complexities during the pandemic. There were staffing concerns, units at capacity, beds that were filled, people very ill with COVID and with other concerns. So was the system stretched considerably? Absolutely. I don’t know if we can say that the hospitals are less safe because clinicians pitched in and did a fabulous job at responding to a very difficult situation.

Avis Favaro

How long have you been a nurse? And what drew you into the practice?

Elliott-Rose

I’ve been a nurse for 23 years. And I started caring for people very young, in my teenage years, as a personal care worker as I was going through high school and then decided to go into nursing after that. It’s really about caring for people, quite honestly, and the relationships with people that are most meaningful and making a difference.

Avis Favaro

And so, in your history, have you ever seen examples of harm where you went, uh-oh, we intended this, but something happened?

Elliott-Rose

So yes. Of course, there have been cases where patient experiences that have not gone the way that we anticipated. Sometimes that is because of the complexity of a particular situation and unanticipated events clinically. And sometimes it’s because something happened in those events where there was preventable harm.

Avis Favaro

And what did you learn from those experiences?

Elliott-Rose

I think that probably the most important thing is the impact on the patient and family and keeping that top of mind. That always keeps you grounded when you’re thinking about nursing care and health care, is the people that are part of that care, the impact on clinical teams because they feel it deeply; we feel it deeply. And then the most important thing is learning from that event.

Avis Favaro

So let’s talk a little bit about the staffing issues that they identified. I know that across Canada, there’s a severe shortage of nurses. And I’m just wondering, in Nova Scotia and at your centre, have you had a struggle keeping nurses?

Elliott-Rose

Absolutely. So we’re in a global health, human resource crisis. Nursing is our largest workforce and certainly the largest workforce for direct care with patients and families. And it is our workforce with the highest number of vacancies.

Avis Favaro

How many nurses are you short right now?

Elliott-Rose

So it depends on the measure you use. So 1,400 to 1,600.

Avis Favaro

That’s 1,400 to 1,600 nurses you’re short? That’s a lot. How do you manage to keep up all the patient care with that?

Elliott-Rose

Well, a lot of innovation. So there’s a lot of innovation happening in Nova Scotia. It doesn’t mean that there isn’t still a number of places that are working short-staffed; that there are a number of nurses working overtime; that we have had to, in some instances, bring in travel nurses, nurses who come in from other places to work. And we’ve expanded a number of our nursing programs so that we get more nurses in. There have been some recognition and retention programs in place.

Avis Favaro

Is it working?

Elliott-Rose

Well, I would say we’re heading in the right direction.

Avis Favaro

So what is your take-home message from this new data?

Elliott-Rose

If we think beyond the number and we think about the context of that number, then there are lots of nuances to that. Right? I don’t think you can say, oh my goodness, this has shifted a couple of percentage or a portion of a percentage, therefore, our system is failing. I think it’s something that we keep an eye on, and we learn from, and we continue to do better. We continue to add resources and we continue to heal from the pandemic and carry on. Right?

Avis Favaro

Last question. What can patients and their families do in regard to preventing hospital harms and supporting the nurses that are on staff working hard? Is there anything that people themselves can do if they’re going to hospital?

Elliott-Rose

I would say come in informed. Ask lots of questions. If there are concerns, raise those concerns immediately with the nurse, your nurse, or a physician or others. Provide lots of feedback because constructive feedback is how we do differently.

Avis Favaro

Those are all good points. And I’m glad that your retention levels are steady.

, thank you so much for joining the podcast. Really appreciate it.

Elliott-Rose

Thanks so much. Thanks for having me.

Avis Favaro

This is the third year in a row that the rate of unintentional harm in hospital has increased. The report also says these are the highest numbers of nursing overtime and sick days. Are the 2 connected?

Joining us now for a closer look is Linda Silas, a Registered Nurse and head of the Canadian Federation of Nurses Unions, which represents a 250,000 nurses across much of the country. Welcome, Linda.

Linda Silas

Hi. So pleased to be here to talk about the working nurses.

Avis Favaro

So, Linda, you’ve seen the latest data from CIHI on hospital harms and staffing. What do you think?

Linda Silas

Yeah. We try to work a lot with any research companies, researchers, and data analysis like CIHI to make sure that what they put out represents the reality. Because sometimes we can be too much in the clouds. You’re up there and you’re not representing the reality. So when I read the newest report, I thought, okay, they’re really connecting patient safety and staffing, nursing staffing.

Avis Favaro

Now let’s look at the data. One in every seventeen hospital stays was linked with harm. What was your reaction?

Linda Silas

I don’t want to be that one in seventeen. But the reality, it happens. Errors or omission always happen. But when you’re working short staffed, it’s like any other job.

Avis Favaro

The report also detailed an increased number of hospital-acquired infections, urinary infections, medication errors, and bed sores. And the number of problems went up during the pandemic, and they stayed up.

Linda Silas

It’s a bit scary. If I just look at the bed sores and medication over, it’s almost 50 percent. That’s 1 out of 2, 1 out of 2 situation where there might be a medication error.

I remember the basic of nursing. You look at your prescription. Was it ordered by the physician? You look at your dosage. Is it the appropriate dosage for that patient? Because maybe the physician made a mistake. And then do you have the right patient? So when you get to the bedside, you have to check. And that’s where errors happen, if you’re interrupted in that flow.

And we saw in England a few years ago, just before the pandemic, there was a lot of talk about errors of medication. And what they did to the medication nurse, they almost put a safety vest on her or him — do not talk to this nurse while medications are being proceed — because there was too many medication errors. Now we’re working so short, nurses are bombarded with different requests when they’re trying to make sure they’re giving the proper medication, which creates complication, length of stay, and of course, bad patient care.

Avis Favaro

Bed sores.

Linda Silas

And that’s, again, when a patient rings that bell and you don’t have time to go. In my days, if I could say it that way, we used to have charts of every 2 hours, patients had to be moved. Mostly the backside and the side of the patient had to be inspected to make sure that there was no indentation, there was no redness. And then the redness turns into white spots, and it progressed. When you don’t have time to do that, bed sores create. That’s infections that you need a specialist nurse, a specialist physician, specialist treatment, those sores, and it can even lead to deaths.

But when you see them increase, it’s automatically a red flag. Why? And the why is there’s not enough staff to mobilize the patients. You know if you ever went for a surgery, the first thing they want to do is get you on your feet. They want to get you walking. Why? They want circulation back, but the circulation is also in your skin to make sure that everything flows well.

Avis Favaro

One other harm that was measured was pneumonia, which you can get from a virus. But you can also develop it when you inhale liquid or food, which I gather could be prevented with adequate nursing attention. Is that right?

Linda Silas

It’s literally when a patient is either coming out of surgery or there’s certain side effects with medication; sometimes it’s age. They can’t swallow properly. But if it doesn’t go down properly, then it goes down on the wrong tube, as we say. So you aspirate it in your lungs, and then that can cause a pneumonia, it can cause coughing, choking, et cetera.

But it’s, again, that attentive observation that you have to look and talk to your patients and test it. Are they awake enough to take their medication, their liquids? Does something else have to be done? And you’re seeing those numbers go up? Again, ask why.

Avis Favaro

So the fact these numbers are going up, how worrisome should that be for Canadians? Some would say it’s only a half-a-percentage increase on certain fronts.

Linda Silas

When I read the harms data, it validated what our bedside nurses, our frontline nurses are saying. Because our stories, some will say that they’re all anecdotal, and yes, they are. But you have thousands and thousands of nurses that are saying, I’m scared I’m not doing my job because there’s not enough staff, I don’t have enough time in my shift. So these data are validating what we’re saying.

I’d not only be concerned by the CIHI data, but I’d also be concerned about all those unreported data. Because CIHI can only report what a hospital puts in their books and reports to CIHI. But there is a whole range of unreported. But what it means for a patient is we don’t have enough staff to make sure that these numbers get at a safe level.

Avis Favaro

So they attached the staffing data, which is the first time that they’ve done this. Does that point to or signify anything for you?

Linda Silas

It signifies that the research community, the data analysis community, are realizing there’s a big change. For years, CFNU published data on overtime and absenteeism. And the last report was in 2017. We continuously told governments the overtime is going up, sick time going up or absenteeism going up. What are we going to do about it? Nothing was being done.

And now you’re seeing reputable organizations like CIHI saying overtime is going up, sick time is going up, and look, patient adverse effects are going up. So we will have to analyze both and say, why are adverse effects or harm or risk are going up? And for us, it’s clear. We don’t have enough nursing staff. They don’t have enough time to do their job properly.

Avis Favaro

What surprised you the most? For me, it was 14 million overtime hours. I have a niece who is a nurse. And when she heard that, she just cringed. She said, I know.

Linda Silas

Yeah.

Avis Favaro

They’re phoning her all the time to fill in and she can’t. She has a family.

Linda Silas

Yeah.

Avis Favaro

But you could see the distress knowing that they needed her.

Linda Silas

The overtime and sick time didn’t surprise me because we hear it all the time that a nurse is called every day. The biggest surprise was the agency nurse. That means the private agency nurses. And they only talked about a 1 percent increase. That surprised me because it’s a lot more than that. Our numbers are showing that full-time nurses numbers are going down. They’re staying within the public sector. But most of their hours are going towards these private agencies.

Avis Favaro

But what’s wrong with this rise in agency nurses? It seems to me that during the pandemic, they needed fill-ins because people were exhausted.

Linda Silas

They need fill-ins all the time. If you look at the Northwest Territories or any of the remote areas, you need agencies and nurses there. In the big cities, you needed some filling. But they were rare occasions. Now, they’re normal. You see a rotation with 10 nurses scheduled; 5 of them are agency nurses. Not only it will break the fibre of solidarity that we have between nurses to go help each other; it’s going to break the bank of hospitals and long-term care in our public system because they cannot afford double the salary. Tells me they woke up and looked at the reality.

We are looking at banning agency nurses across the country. It’s just some governments are more reluctant because they see all these vacancies. And I’m saying, why don’t you work with your nurses’ unions to see what is needed to keep committed employees? Well, what is needed is guaranteeing that after my shift, my 12-hour shift or my 8-hour shift, I can go home. Right now, there’s no guarantee of a permanent employee taking a shift that he or she will be able to go home after the end of their shift. Why does a pilot have so many hours in a week, in a month that he or she can do because of the security of the passengers? Or a truck driver? Or a bus driver? But in nursing, there’s no limit. We have precious cargo too, and it’s our patients.

Avis Favaro

Do you think the study or the data will help you?

Linda Silas

Yes. Any data that is done by credible organization helps us. So we will use the data to help our research teams to produce better policies on hours of work on workload, such as nurse-patient ratios.

To look at a good-news scenario, British Columbia, Nova Scotia are looking at safe staffing models. And that’s coming from government level, saying we need to guarantee to patients in our province that we will provide safe nursing staffing so you get good care.

Avis Favaro

Can you explain to Canadians why so many nurses are leaving staff positions?

Linda Silas

You know, 36 percent of nurses in Canada have shown burnout sign, major depression, anxiety levels. That is very high. And they’re looking at their managers and just saying, I can’t do it. And managers are saying, sorry, you have to. And that is causing nurses just to leave. And that is putting a lot of pressure on nurses to say, why? Why would I do that to my body? I may as well just take a part-time or a casual job and deal with accepting overtime shifts or agency shifts.

Avis Favaro

It’s a very sobering and troubling report, I think. And also discouraging because the health care system that’s so important to Canadians feels pretty battered. Are you at all optimistic, Linda?

Linda Silas

Good question. First, I think I’d still encourage any young person to go in nursing. It’s a beautiful profession and I’m optimistic we’re going to fix it again. We were in this mess in the late 1990s. Some might remember you would’ve hearing nurses only finding jobs in the US, all leaving because we thought we had too many nurses, we thought we had too many doctors. So we kind of cut the nursing school and realized we made a mistake. We fixed it.

But don’t get discouraged. I truly believe that everyone from every level of government, from every agencies — and when I say agencies, it’s agencies like the CIHI — is really working towards what evidence can we give managers and policy-makers to make the workplace better because the conditions of work are the condition of care. And we really have to improve the conditions of work so the condition of care becomes excellent, and we will.

Avis Favaro

Terrific. Thank you so much, Linda, for being on the podcast.

Linda Silas

I thank you.

Avis Favaro

The reason that hospital harms are tracked is because they carry a cost to the health and the lives of patients and their families.

So joining us now is Kathleen Finlay, whose mother, Lorraine, fell at home and started her on a road of hospitalizations. Kathleen, thank you for joining us.

Kathleen Finlay

It’s so good to be with you, Avis.

Avis Favaro

Thank you. So your mom fell. That’s a really common story, older adults falling. How old was your mom at the time?

Kathleen Finlay

She was 88 at the time, and she was in very good shape. She did a lot of things on her own.

Avis Favaro

How severe was her fall? How bad was her condition?

Kathleen Finlay

She fell down the flight of stairs between the second floor and the first floor. It was very early in the morning. She had just gotten up. I heard this terrible noise. It was my mother. She was lying at the bottom of the stairs, and she was unconscious. I couldn’t awaken her. There was blood, and it looked like she had some broken bones as well. So it was very, very serious.

Avis Favaro

One of the things that you think when you bring your loved one to a hospital is that they’re going to be made better and it’s going to be safe.

Kathleen Finlay

Yeah. Absolutely. And I expected, once I got over the trauma of what I had witnessed that morning, I expected that things would be done with redundancies and double checks and it would be almost like NASA, that everybody knew what they had to do. They would do it in the right order. It would always be done properly. There wouldn’t be any failures.

Avis Favaro

So what happened to your mom?

Kathleen Finlay

So in the trauma unit, she did really well. Within a week, she was talking again and recognized everybody, enjoying family pictures. We could have conversations. She was asking about what happened to her and why she was there. And at that point, we were promising her she was going to go home very soon.

She was given a combination of medications in the step-down unit that we are told by experts should never be given to people with brain injuries and especially not older people with brain injuries. And she suffered a cardiac arrest.

Avis Favaro

Her heart stopped.

Kathleen Finlay

Her heart stopped and her breathing stopped.

Avis Favaro

How did you learn or when did you learn that the medications were given in error?

Kathleen Finlay

There was an admission, although it was not quite an admission, by the staff doctors at the hospital that it perhaps shouldn’t have been done that way. But when I started to dig into it, when I started to consult with experts, I was told that those medications should never be given in combination to anybody who’s had a brain injury. That would not be best practices. And that they certainly shouldn’t be given in combination to an older person with a brain injury.

Avis Favaro

So were they able to revive her?

Kathleen Finlay

Yes. But she came out of it a very different person. It was the beginning of a 6-month-long ordeal in the hospital that just kept getting worse and worse and worse. She suffered aspiration pneumonia, a major seizure, other medication errors, and complications like malnourishment, a very bad pressure ulcer. And you can see the trajectory just goes down from there.

Avis Favaro

How did you feel about that?

Kathleen Finlay

I went through all the stages. I was quite angry. I was very worried about my mother and her prospects for survival. But I was really concerned with the way the hospital dealt with the situation. It was the kind of situation where you’re fighting for the life of your loved one, but you’re also fighting to stay connected to the care team in a way that helps that person and doesn’t harm them further. It’s a delicate, delicate balance.

Avis Favaro

What happened towards the end of her life?

Kathleen Finlay

When she came home, she was in not the greatest shape, but we got her out of the hospital after 6 months. But she was home, and she was safe, and she really enjoyed being with us. It was quite wonderful.

Avis Favaro

So you had some good years then. But then there was another hospitalization. And was there an error there? Or was it a continuation of the problem that started the first time she was in hospital?

Kathleen Finlay

No. I think these were new errors. We noticed over Christmas that her breathing became quite laboured, and she seemed to be in some kind of distress. So we had the paramedics come and they advised taking her to the hospital, which we did. She was diagnosed initially with a urinary tract infection, which is fairly common, not that surprising, and she was given the wrong antibiotics for that particular infection. She was given fluids to replenish the fluids that she had lost. And they were not monitored overnight for the entire overnight shift, apparently.

And when I went in to see her the next morning, her body had just gained so much fluid weight. Her face looked like a balloon. She was not recognizable, and she was in such distress and pain. It was really difficult.

Avis Favaro

So you ended up taking her home.

Kathleen Finlay

We got that situation stabilized and we took her home for what we knew would be the last few days of her life. But there were some really awful things that happened to her in the hospital that I think could have and should have been avoided.

Avis Favaro

What happened to your mother turned you into a patient advocate.

Kathleen Finlay

Yes. I don’t have a medical or health care background, so I just — I consumed thousands of pages of research. I talked to other people that I knew who had experienced similar things in hospital. I started to write a lot and people started to contact me a lot. And I established the Center for Patient Protection and patientprotection.healthcare as an advocacy clinic and as a way of advancing that advocacy to promote change in hospitals and how they deal with patients and families in these situations.

Avis Favaro

Are you hearing from people still now?

Kathleen Finlay

Oh yes. The situations are all different, but the common thing about it is, they wouldn’t listen to me. This is what people say and this is what I felt; they wouldn’t listen to me. The evidence is that family members of patients are an excellent early warning system in the hospital. They can recognize a deterioration in a loved one’s condition much faster than clinicians can. And this is something that has been borne out by the research. Family members are so upset when they are not listened to. And as a result of not listening, a patient encounters another form of harm.

Avis Favaro

The latest CIHI data found that the hospital harms are at the same rate during the COVID pandemic and in the years here that have followed. It is up from before, but it stayed steady. We know that the hospital system and the health care workers are under severe stress and they are short-staffed on a number of different fronts.

How do you differentiate between solving the problem and the blame that comes from workers who I know generally are trying their best?

Kathleen Finlay

Yeah. I don’t think this is about blame. I think it’s about protecting patients. I think apology needs to become the new normal. There can be apologies without blame. And that’s what patients and families want, just a human being saying, what you went through was terrible and it shouldn’t have happened, and we are so very sorry. And why can’t we make that the new normal?

Hospital workers definitely are stressed. And this is one of the reasons why I think the patient, the whole family-centred patient safety movement sort of went quiet during COVID because people didn’t want to put on more stress, and everybody recognized that it was a very bad situation for frontline workers. But in that, they lost the family caregivers who were looking over the patients and being that early warning system.

Avis Favaro

Well, I want to thank you for sharing your story and your mom’s story.

Kathleen Finlay

Thank you, Avis. Nice to talk to you.

Avis Favaro

The new CIHI report also found that hospital harm rates are higher for people 65 and older and more men experience harm during a hospital stay than women. It’s all fodder for more research. There’s more detailed information on the report. You can find that on the website. Go to cihi.ca.

Our executive producer is Jonathan Kuehlein. Our production assistant, Heather Balmain. And a shout out to Alya Niang, the host of our French CIHI podcast. And subscribe to the CHIP wherever you get your podcasts. I’m Avis Favaro. Talk to you next time.