Most of us will rely on Canada’s health systems at some point in our lives. And while we will likely receive safe and effective care, health care delivery always carries a risk of unintended harm. These harms can lead to prolonged hospital stays, disability or even death. Everyone has a role to play in patient safety — from health care providers to patients and families. We spoke with Yana Gurevich, manager of Health Indicators and Client Support, and Mélanie Josée Davidson, director of Health System Performance, about patient safety and how CIHI is helping to make patient care safer in Canada.

Why is patient safety such an important issue for Canadians?

Yana Gurevich, Manager, Health Indicators and Client Support, CIHI

No one expects to be harmed when they are in a health care setting, but it is widely recognized that unintended harm happens. In fact, we know that in Canada, 1 in 18 hospitalizations leads to a harmful event. There are a number of studies that show that these may be prevented by implementing best practices, and by reporting and monitoring. That is why it is so important. Sharing and learning from these harms can help prevent them from happening again.

What is CIHI doing to help Canadians receive safer care?

Back in 2007, we launched the Hospital Standardized Mortality Ratio indicator, which reports on hospital deaths. For the first time, Canadian hospitals could assess their mortality rates and identify areas for improvement to help reduce them. Since then, we’ve introduced a number of quality and safety indicators in the acute care and long-term care sectors. Our Your Health System tool reports on issues like bedsores, falls and infections. Most recently, we partnered with the Canadian Patient Safety Institute (CPSI) to develop the Hospital Harm indicator, which looks at a wide range of potentially preventable harm in acute care. All this information gets directly fed back to facilities to help inform their quality initiatives and ultimately improve care for their patients.

How is Canada doing compared with other countries when it comes to safe care?

Mélanie Josée Davidson, Director, Health System Performance, CIHI

Mélanie Josée Davidson, Director, Health System Performance, CIHI] Measuring patient safety internationally is not an easy endeavour. Countries need to have mature data systems to capture patient harms. That, and a very strong patient safety culture to report incidents of harm without facing repercussions, so that others can learn from the experience. It is widely believed that Canada’s information reporting system is among the best. The Organisation for Economic Co-operation and Development (OECD) developed a number of indicators, which allows for international comparisons in areas like patient safety. No country does well on all aspects of patient safety and quality of care. We know that in Canada, there is room for improvement. We have made some progress in areas like hospital mortality and hospital-acquired infections, but Canada is in the bottom quarter of OECD countries for other patient safety measures, such as rates of obstetrical trauma and some surgical complications. There is a definite opportunity to learn from what other countries are doing and to apply best practices.

CIHI has the OECD Interactive Tool that allows people to see how Canada is doing in relation to other peer countries. For those who are interested in our international work, we will be releasing updated OECD information — including patient safety data — in early November.

What do you think can be done to cultivate a culture of sharing and learning when it comes to patient safety?

One of the biggest challenges with monitoring patient safety is the under-reporting of incidents. The thing is, the better a hospital is at reporting safety incidents, the worse their performance looks. A hospital that is very good at reporting their safety incidents might be picked on for having poor performance, when in fact it could be that they are more transparent. We need to eliminate the fear of blaming and shaming. This is a learning opportunity to prevent future harms.

CPSI has a whole body of work devoted to cultivating a culture of patient safety. There are a number of tools and resources for individuals looking to improve patient safety in their organizations.

What role can patients and families have in patient safety?

From our patient experience work, we know that communication is one of the most critical parts of the health care process. An open dialogue about what you should be expecting in your care and what’s normal and what’s abnormal is one of the first things a patient can do to inform themselves and flag when things aren’t going as they should be. It’s important for patients to know that they can, and should, speak up if something doesn’t feel right.

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