CIHI data helps promote a culture of safety: Hospital using the HSMR to track improvement efforts


While other facilities in southern Ontario have battled some significant infection outbreaks, to date, Brantford General Hospital has managed to avoid them.

“It seems like we’ve been an island of cleanliness,” says Jim Hornell, President and CEO of Brant Community Healthcare System (BCHS).

“That’s more than just luck. It’s because we’ve invested in handwashing.” Patient safety has been a corporate priority at BCHS since 2007. But the impetus for change dates back to 2003, when the SARS outbreak killed 44 people in Ontario.

“SARS changed everything,” says Kathy Stauffer, BCHS Board Chair. “We’d been reactive. But when you’re dealing with people’s lives, you have to be proactive. You don’t want people coming into the hospital to get sick. This is a place where you’re supposed to get better.”

Led by Lynn Vogt, Manager of Risk, Quality, Patient Safety and Patient Relations, Brantford developed a comprehensive three-year plan to eliminate the risk of infection in the hospital. Significant investment was made in handwashing, and there was a shift to “no blame, no shame” around adverse events, which saw reporting increase 540%.

To track its patient safety efforts, the hospital began paying close attention to its hospital standardized mortality ratio (HSMR). Developed for use in Canada by CIHI, it allows hospitals to assess their mortality rates and identify areas for improvement.

In addition to hiring two infectious disease specialists, Brantford created a decision-support team to mine data, research trends and help teams identify good practice and where they need to change. To address medication errors, the hospital launched a medication reconciliation plan and introduced a new computerized bedside medication verification system—the first in Canada. It also opened a new, fully automated lab—another Canadian first. Throughout this process, CIHI’s HSMR has been front and centre on a corporate scorecard of quality and safety indicators. Vogt says it’s their baseline.

“It’s your big-dot indicator on really, how safe is your hospital? You certainly want to know how safe are you, overall, and how do you measure compared to others.”

Brantford’s efforts are paying off. In just three years, its mortality ratio has dropped more than 40%. In 2010, the hospital had the lowest HSMR in Canada.

“The numbers don’t lie,” Stauffer says. “If you can’t measure it and you can’t monitor it, you can’t manage it. The data drives these initiatives. It is imperative to your success.”