How we define patient safety and harm has real consequences for patients, their essential care partners and people working in healthcare. The definition has evolved over time and continues to change in response to the world around us. Through the Redefining Patient Safety project, Healthcare Excellence Canada (HEC) is working to redefine patient safety and harm by inviting thoughts, opinions and insights from a wide variety of people. It’s part of a creative strategy that will help to improve patient safety outcomes with the involvement of people like you.
The history of patient safety
Patient safety didn’t always have our attention the way it does today. Until recently, when harm occurred it was thought of as an inevitable consequence of healthcare, and discussions about patient safety were scarce for both patients and providers. However, emerging research and innovations in practice, combined with increased public awareness and a strong commitment from care providers and leaders, have played a pivotal role in bringing patient safety to the forefront.
As safety science evolved, the definition of patient safety and incidents changed with it. The initial focus was on safety incidents that caused physical harm. Then in 2009, the World Health Organization expanded the definition of a “patient safety incident” to include not just harmful incidents but also near-misses (or patient safety incidents that did not reach the patient and therefore did not result in harm). The Canadian Patient Safety Institute – which recently amalgamated with the Canadian Foundation for Healthcare Improvement to form HEC – adopted this definition in Canada and incorporated it into all of our work. This resulted in better patient safety programs, policies and practices (e.g. disclosure, incident analysis, and learning from reporting).
Although this expanded definition helped broaden our thinking, we now need a new definition that reflects how society, safety science and practice have evolved, including the fact that cultural safety or racism are forms of patient harm. The pandemic has shown how the most vulnerable and marginalized are exposed to preventable safety incidents; it’s also underscored the need to better care for the people in the workforce because their physical and psychological safety is essential for patient safety.
“We know that the way a patient and family define patient safety is different from providers or insurers,” says Ioana Popescu, Director, Safety Strategies and Programs at HEC. “I really like the quote ‘words create worlds’ because it reflects what I have seen happening in patient safety over the last decade. The words we use to describe patient safety will create the world in which patients and providers experience care.”
Why redefining patient safety matters
Redefining patient safety will make it easier to identify, evaluate and ultimately create patient safety, not just prevent harm. Each time we’ve defined patient safety – naming it in the 1990s or expanding it in 2009 – it’s helped us broaden our perspective, leading to better safety programs, policies and practices. It’s now time to give more people a voice in redefining patient safety.
“We’re going from labelling when and how harm is done, to a system of checks and balances, to finally opening up our view to all the ways a person can be affected by safety. A lot of voices aren’t getting representation and as they’re brought forward, we need to include them to create a modern standard of patient safety,” says James Rebello, Program Intern, Safety Strategies & Programs at HEC.
A new definition of patient safety needs to include the voices of those with lived experience in the healthcare system and those who have been systemically and structurally excluded. We need to make room for concepts like cultural safety, financial safety and other ways people experience patient safety and harm.
Redefining patient safety in this context is a crucial step in charting a path to a future where everyone has safe and high-quality healthcare.
Developing a new definition in a new way
HEC is developing a new definition of patient safety differently – by inviting more people to contribute to a definition that serves more people. With support from UHN OpenLab, HEC is broadly engaging with different people, industries, regions and institutions to facilitate a thought exchange.
“It's a totally different approach. We, of course, did the review and research, but we’re also eliciting broader thoughts from people who are not the usual suspects,” notes Rachel Gilbert, Senior Program Lead, Programs & System Transformation at HEC. “This divergent exploration and creative openness is going to help us redefine patient safety.”
Let’s redefine patient safety together
A new definition of patient safety will influence programs, policies, procedures, standards and interactions at point-of-care. By incorporating different views and experiences like yours, we can make sure that a new definition reflects the lived experience of diverse people and populations.
The project’s virtual discussion space survey is open until Jan 15, 2021. This is your chance to shape the system by answering, what does patient safety mean to you?
Join the discussion today and share with others!
Today, you could shape the definition. Tomorrow, you could see how it helps to shape patient safety in the system.