Small Changes. Big Impact. Safer Care.

October 25, 2023

Small Changes. Big Impact. Safer Care.

Like many families, mine has seen life-changing outcomes from unsafe care; and we’ve seen how concerted action can make care safer. My grandmother lived a very active life and ended up needing several hip and knee replacements. During one surgery, she was given a blood transfusion that was infected with Hepatitis C. We didn’t know it then, but in a few minutes, her life changed forever.

However, if I needed the same operation today, I wouldn’t face the same risk. A safer blood supply and surgical practices that reduce the need for transfusions are now the norm everywhere across the country, every day of the year. These outcomes were not created in a single stroke by one person or even one organization. Rather, they are the result of many, many actions by a large number of people, many of whom have never met.

Experiences like these are echoed  in the theme we chose for Canadian Patient Safety Week 2023: Small Changes. Big Impact. Safer Care.

It’s work that we need to continue to do because the dramatic improvements in safety between my grandmother’s generation and mine in the safety of the blood supply are not everyone’s experience. In fact, improvements in healthcare safety have not come as swiftly—or deeply—as many of us had hoped. Recently released data from the Canadian Institute of Health Information show that one in 17 hospital stays in Canada in 2022-23 resulted in unintended harm that might have been prevented through evidence-informed practices. That’s about six per one hundred acute-care admissions, up from rates of 5.3 to 5.4 before the pandemic began.

Canada is by no means alone in seeing these trends. Harm rates have also risen in the United States, United Kingdom and other countries. “The safety movement has, at best, stalled,” said Don Berwick recently, an international safety expert. He urges healthcare executives and boards to “push patient safety back to strategic prominence,” because “first do no harm” remains “a sacred obligation for all in healthcare.”

Getting unstuck means recommitting to a focus on safety – and rethinking how we can accelerate the move towards safer care. In recent months, we’ve connected with hundreds of people across the country to help shape the path forward. This year’s Canadian Patient Safety Week focus reflects what we heard, coupled with international frameworks that bring in global evidence.

Step 1 is championing a comprehensive approach to healthcare safety that takes a much wider lens. Safety is more than the absence of harm. The person in the hospital bed next to my grandmother might have been lucky enough to avoid infection but that does not mean they were safe. We need to balance the reduction of harm with proactively promoting safety.

Also, all forms of harm matter. Historically, we have tended to focus on physical harms that were easier to measure, such as falls or healthcare-acquired infections. We need to add consideration of other forms of harm, such as under- and over-treatment, delayed or incorrect diagnoses, dehumanization, and psychological harm. And it’s not yet true that everyone – regardless of what they look like, where they come from, who they love, the language they speak, or other characteristics – is equally likely to receive safe care.

We have work to do.

The good news is we have proven and promising approaches to do that work. Everyone contributes to patient safety. Together, we can learn and act to create safer care and reduce all forms of healthcare harm. This includes recognizing that the safety of those providing care is closely linked with patient safety.

The process is not always complicated. Recently, for example, I had periodontal surgery. When glue on a stent tore out some stitches, I bled. A lot. After dealing with the bleeding, I asked how we could reduce this risk in the future. The periodontist and I had a conversation about options, and we’ve agreed on what to do for my next round of surgery in the new year.

On its own, this is a small change. But an accumulation of small changes can add up to big impact and safer care.

Together, we can find ways to promote safer care by creating environments that encourage dialogue and promote exploration and curiosity for all.  This includes looking upstream – exploring, learning and acting before harm occurs. Plus recognizing when, why and how things go well.

Let’s unleash the potential everyone has to contribute by thinking about steps we can take on an everyday basis to help make care safer:

  • How can we add curiosity and proactive inquiry to our daily practice, balancing assurance and accountability?
  • How can we enrich our safety metrics with “soft intelligence” gathered through listening, observing and perceiving?
  • How can we move from ‘safety as a project’ to safety as a way of thinking, responding and acting?
  • How can we include patients, families, and everyone working in healthcare in improving safety, not just quality and safety departments?
  • Are there opportunities to coach for safer care, rather than focusing only on retrospective auditing processes and practices?
  • How can action on patient safety help reduce health inequities and how can action on health inequities lead to safer care?
  • And can we move from a “rear-view mirror” approach to safety to one that is proactive?

Change is possible. Join us in exploring how small changes can add up to a big impact – ask questions, engage in safety discussions and take action proactively.

Check out our free campaign resources:

  • Explore Rethinking Patient Safety, a discussion guide explaining the new approach.
  • Engage colleagues in identifying opportunities for safer care using activity cards, such as a ‘Digging for Dinosaurs’ contest, a fun, constructive and non-threatening way to encourage healthcare teams to reflect on their work practices and identify those that bring value to safer care and those that may not.
  • Join our Action Series, a dynamic four-month virtual program to broaden your understanding of safety, empower you to adopt a proactive safety approach and enhance your organization's patient safety culture.
  • Share a quick video introduction to the new approach to safer care to broaden the circle of those working together.

Learn more and access other resources at

Jennifer Zelmer, PhD

President and CEO, Healthcare Excellence Canada