Working together to improve patient safety

September 14, 2023

Working together to improve patient safety

By Alies Maybee (Patient Advisors Network), Kathy Kovacs Burns (Patients for Patient Safety Canada), and Adrienne Zarem (Healthcare Excellence Canada)

As World Patient Safety Day approaches on September 17, this year’s theme of “Engaging Patients for Patient Safety” highlights the vital role patients, families and essential care partners play in the safety of healthcare. In the spirit of this year’s theme, we as patient partners are sharing our reflections and identifying opportunities to make care as safe and high-quality as possible.

Our healthcare system depends on everyone, at all levels, working together to provide safe and high-quality care. We know when we work together, our outcomes improve and we have more positive experiences in the system. We also know staff feel more positive about their work when they engage meaningfully with us. Many patients receive safe and high-quality care, and we hope this type of collaborative care centered on our needs continue to spread.

But we are not naïve. Our systems remain unsafe. We know many patients also experience harm, both physical and psychological, across all parts of the health system. Our current approach to patient safety has brought us only so far. We need to think and act differently. Everyone has a role to play in patient safety. To create a safer system, it is essential to engage with us meaningfully and consistently as partners.

A shared responsibility

Care isn’t a one-sided journey. We see how shifting the system from care designed for patients to care designed with patients improves outcomes, enhances experiences, and fosters trust and relationships between patients and the care team.

Kathy: Most healthcare settings are short-staffed. Time constraints and high patient volumes negatively affect the quality of communication between healthcare providers and their patients. But even small acts can make a difference. A 20 to 30-second check-in with patients to see how things are going, or an invitation for patients to ask questions go a long way in empowering patients. On the patient side, preparing questions in advance and being proactive help patients make the most of their appointments to make informed decisions.

Alies: Providers should also welcome patients who search through online sources (such as Google) to understand their care. It starts a conversation between the provider and the patient. By holding space for dialogue, patients start to share in their health decisions and take responsibility for their care, treatment and the risks involved. This opportunity to address misinformation or disinformation helps move patients away from unsafe decisions to provider-informed decisions.

Kathy: Patients advocating for themselves and asking questions about their care and treatment are opportunities to minimize risks. Good care is safe care. When communication and trust between providers and patients shut down, care suffers. We saw this during the pandemic when restrictions limited people’s access to care (like going to emergency departments), or made people feel unsafe about going for in-person care.

Inviting patient partners

By inviting diverse perspectives into decision-making, we design an environment of safer care. Purposeful patient engagement is fundamental to transforming the health system. We as patients, caregivers and community members offer lived experience expertise that leads to sustainable improvements in quality and safety of care.

Adrienne: My child was a flight risk whenever we were in care settings. If providers didn’t invite me to share this information, they likely would find themselves in unsafe situations where my child would run off. Creating an environment of safer care means having providers who not only value our perspectives but who actively invite us to share relevant information and be part of the circle of care.

Alies: Beyond inclusion, we also need to train patient partners with the knowledge they need to contribute. Otherwise, it can be a 10-year learning loop as it was in my experience. This includes understanding the nuances and structures of the system – from patient and provider workflows to the complaint mechanism of healthcare settings.

Encouraging a culture of learning

We know a culture of safety is a culture of learning. By encouraging curiosity and exploration, organizational leaders can cultivate these environments in our health systems.

Alies: Unsafe care goes beyond patient safety incidents. It also comes from structures and culture – like the culture of blame and shame – that cause harm. This culture is a safety issue because not accepting failure means higher risks of repeating mistakes and reduces chances for learning.

Adrienne: In addition, the language of complaints tends to be cast as negative. But if we reframe complaints into useful information that can improve the system, we start creating a culture of safety (“We need your input” versus “We’ll accept your complaint”).

Kathy: Perspective matters. How do we prevent safety incidents from happening again? We want to learn from these lessons. Engaging openly and proactively in these conversations are ways to reduce the risk of harm. It’s a way to shift the culture from one of blame towards a culture of learning and harm prevention.

Systemic changes for safer care

Our health systems work best when providers have all the information needed to support a patient’s care. We feel particularly vulnerable when transitioning from one part of the system to another, or even from one provider to another, because the flow of health data is at times inadequate.

Alies: When providers lack complete data when making diagnostic and treatment decisions, our safety is at risk. There are concrete ways to improve care from updating privacy laws to adopting standards for data sharing across our health systems. These changes support us as we move from care site to care site or provider to provider.

Adrienne: Providers need others to help create a safe environment. When information flows between a unified care team, we cultivate safer care.

Understanding broader forms of harm

To create safe environments, we need to expand our own understanding of harm. Engaging patients for patient safety means seeking out patient experiences and understanding what harm and safety means from our perspectives. Many recent examples highlight how cultural safety is patient safety. Stories like that of Joyce Echaquan, an Atikamekw First Nation woman who died in a hospital due to racism, painfully illustrates how patient harm exists in many forms.

Alies: If we want a system that is safe for all, we need to understand the ways in which care is impacted by racism and other forms of discrimination. We need to elevate voices of those who routinely suffer harms due to an aspect of who they are – culture, colour, gender, language, etc. If we design a system according to the needs of those who experience discrimination, oppression and resulting lack of access to safe care, then the system will be safer for all.

Adrienne: We also need to recognize implicit and unconscious bias. Even those who do not see themselves as having these biases can unconsciously act in a way that causes harm.

Kathy: It goes back to putting the patient at the centre of care and supporting them to openly communicate what safe care looks like for them. Care can only be deemed to be culturally safe by the recipient of care. It's not about care providers needing to understand everything about how a patient identifies (for example gender, ethnicity, spirituality, etc.) but about creating an environment and relationship which allows for open and respectful communication. Using this approach allows providers to actively work to respect their patients’ uniqueness while providing safe and appropriate care.

What’s next?

Safer care begins with openness, transparency, and the recognition that we all need to work together to improve care. Everyone in Canada wants and deserves safe, high-quality healthcare – and together we can make that possible.

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