Glossary of Terms 

This Glossary defines and describes the terms used in the Engaging Patients in Patient Safety – a Canadian Guide. When appropriate, use your organization's preferred or commonly used terms. 

Accreditation: A self-assessment and external peer assessment process used by health and social service organizations to accurately assess performance levels against established standards, and to implement ways to continuously improve. 

Culture of safety: Culture is "the way we do things around here." Culture refers to people's shared values (what is important) and beliefs (what is held to be true), which interact with an organization's structure or system to produce behavioural norms (what people do). 

Positive safety culture: Communication is open and honest, there is mutual respect and trust among providers and patients, people are comfortable reporting safety concerns, and there are fair and just processes in place to examine, address, and learn from failures. 

Disclosure: A formal process to openly discuss a patient safety incident with the patient, their family, and members of the healthcare organization.  

Engagement: An approach to encourage the people most impacted to participate actively in defining their issues of concern, and help decide, plan, deliver, implement, evaluate, and improve initiatives, processes, and/or policies. Ongoing engagement involves developing and sustaining constructive relationships, building strong, active partnerships at various levels across the healthcare system, and holding a meaningful dialogue with partners. Types of engagement include surveys, consultations, and shared decision making, as described in the spectrum of engagement. Effective engagement is goal-focused, decision-oriented and values-based.  

Patient engagement: An approach to involve patients, families, and/or patient partners in:  

• Their own healthcare 
• The design, delivery, evaluation of health services 
• A way that fits their circumstances 

Patients' experiential knowledge is recognized; and power is shared in ongoing, meaningful, constructive relationships at all system levels:

• Direct care 
• Healthcare organization (service design, governance) 
• Health system (setting priorities and policies)   

Public engagement: involving the public/ citizens before or after they access the healthcare system (e.g. make healthy and informed decisions regarding care)  

Spectrum (continuum, levels) of engagement: The range of ways patient engagement takes place. It can span from input and consultation to shared leadership, accountability, and decision making.   

Evaluation: Collecting, analyzing, and using data and information to understand how a project, program, or policy is progressing and/or what is its impact on individuals, organizations, and/or society. Evaluation often measures success or importance in relation to goals, objectives, and needs. 

Incident analysis (or root cause analysis):  Structured, rigorous, often legally-protected and confidential process to review a patient safety incident. It identifies what happened, how, why it happened, what can be done to reduce the risk of recurrence and make care safer, and what was learned. It examines the whole system of care to identify the factors that contributed to the patient safety incident. 

Incident management:  Various actions and processes required immediately and on an ongoing basis following a patient safety incident. It includes immediate response, disclosure, incident analysis, sharing and learning. 

Patient and family: 

• Patient: Person who is receiving, has received, or has requested health services. It refers to all other terms for patient, including client, resident, person, and individual. 
• Family: Person(s) whom the patient wishes to be involved in their care, and act on their behalf or interests. Family is defined by the patient. This person speaks up on behalf of the patient with the patient's input. 

Note: because of the inconsistent terminology some use the term "those most impacted" instead of patient. 

Patient partner (or advisor): An individual who experienced care in the healthcare system (as a patient, family member or caregiver) and who, as part of a patient group (e.g., patient/family council), engages in shaping decisions, policies, and/or practices at all system levels. 

Patient representative: An employee working in a healthcare setting who helps patients and families with their specific concerns, and answers their questions while in a healthcare facility. This person is the link between patients/ families, and providers/ organization.  

Person (Patient, family) Centred Care: An approach to care where patients and healthcare professionals partner to: 

• Give patients a voice in the design and delivery of the care and services they receive 
• Allow patients to be proactive in their healthcare journey for better health outcome; and 
• Improve the experience of patients 

People-centred care: An approach to care that consciously adopts individuals', carers', families' and communities' perspectives as participants in, and beneficiaries of, trusted health systems that are organized around the comprehensive needs of people rather than individual diseases, and respects their preferences. People-centred care is broader than patient and person-centred care, encompassing not only clinical encounters, but also including attention to the health of people in their communities and their crucial role in shaping health policy and health services.

Patient empowerment (or activation): Helping patients gain control over their own lives and increase their capacity to act on issues that they themselves define as important. Aspects of empowerment include self-efficacy, self-awareness, confidence, coping skills, and health literacy.  

Patient experience: The sum of all interactions, shaped by an organization's culture, that influence patient perceptions, across the continuum of care. 

Patient safety: The pursuit of the reduction and mitigation of unsafe acts within the health care system, as well as the use of best practices shown to lead to optimal patient outcomes. Patient safety is one of the dimensions of quality.  

• Patient safety incident: An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. It includes: 
• Near miss: A patient safety incident that did not reach the patient. Replaces "close call." 
• No harm incident: A patient safety incident that reached a patient, but no discernible harm resulted. 
• Harmful incident: A patient safety incident that resulted in harm to the patient. Other terms sometimes still used to describe a harmful incident are: adverse event or critical incident. 

• Patient safety science: Methods to acquire and apply safety knowledge to create highly reliable systems that approach "fail-safe" conditions (i.e., those in which the operator cannot perform the function improperly). Past effort has been directed toward developing defences, which are barriers that prevent an unsafe act from resulting in harm. Over the years, healthcare has developed many of these barriers, and usually several must be breached for patient harm to occur 

Measurement: A process essential to monitoring success. It indicates what's working and what's not, and can provide evidence for others to improve the quality of patient safety. 

• Measures (metrics): Standard for determining an organization or initiative's activities and performance. 
• Performance measures: Monitors, evaluates, and communicates the extent to which various activities of the organization or the healthcare system meet their key objectives. 
• Process measures: Assesses what is being done and how (e.g., engagement activities, strategies or methods which directly affect the outcome), what is working well, and what needs to be changed or improved (e.g., the delivery of timely prophylactic antibiotics to reduce surgical site infection). 
• Outcome measures: Determines what effects the engagement had, what it did or did not accomplish, and what success looks like (e.g., to reduce falls, teams should measure the number of falls). 
• Balancing measures: Determines if improvements in one part of the system were made at the expense of other processes in other parts of the system (e.g., in a project to reduce the average length of stay for a group of patients, the team should also monitor the percent of readmissions within 30 days for the same group). 

Providers (or clinicians): Includes physicians, nurses, and allied health care professionals who directly provide healthcare services to patients. The term does not include the family members providing care (family caregivers or care partners). 

Quality of care: The degree to which healthcare services produce the desired health outcomes and measure up to current evidence and knowledge. The attributes most often used to describe quality care are safe, patient-centred, accessible, appropriate, effective, efficient, and equitable. Each province or organization may have their own quality frameworks.   

Quality Improvement: A systematic approach to making changes that lead to better patient outcomes and stronger health system performance. It involves applying quality improvement science, which provides a robust structure, tools, and processes to assess and accelerate efforts for testing, implementing, and spreading good practices. 

Information 

• Qualitative information : Descriptive information, such as patient stories, notes from interviews or focus group discussions, and observation notes. Qualitative information can be systematically analyzed to identify issues of interest. 

• Quantitative information: Information that measures characteristics using a numeric value (e.g., gender, income, marital status, etc.). The numeric values can be statistically analyzed to identify issues of interest. 

Stakeholder:  A person who has a vested interest in engagement outcomes and who could be affected by any decisions taken or changes made. Stakeholders could include: patients, families, caregivers, providers, administrative staff, suppliers, organizational partners, the community, the public and others. 

System levels: The healthcare system is comprised of many sub-systems operating at different levels (e.g., outside of the organization, within the organization and/or program level, at point of care) each with specific goals, resources (e.g., human, financial, equipment), and formal or informal processes. 

• Point of care: direct care (patient and family receiving care and providers and others who deliver care and services) 
• Organization: program/ unit/service and facility/organization/ health region (service design and delivery, strategy, system planning, organizational design, governance) 

• System: the sum of all the organizations, institutions, and resources that deliver health care services to meet the health needs of a target population (policy, planning, resourcing, research, education, accreditation) 

Validated tool/survey/questionnaire: A measurement tool that has been tested for reliability (produces consistent results) and validity (produces true results). 

References 

• Healthcare Excellence Canada. Patient Safety and Incident Management Toolkit. Glossary. 2015. 
• Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood). 2013 Feb;32(2):223-31 
• Charles Vincent, René Amalberti. Safer Healthcare. Strategies for the Real World. Springer, Cham. 2016. 
• Emanuel LL, Taylor L, Hain A, Combes JR, Hatlie MJ, Karsh B, Lau DT, Shalowitz J, Shaw T, Walton M, eds. The Patient Safety Education Program – Canada (PSEP – Canada) Curriculum. © PSEP – Canada, 2016. 
• European Patients Forum. Patient Empowerment: https://www.eu-patient.eu/policy/Policy/patient-empowerment/ 
• Health Quality Council of Alberta. The Alberta Quality Matrix for Health.     
• Health Quality Ontario. Quality Matters: Realizing Excellent Care for All. 2015.     
• Institute for Patient- and Family-Centered Care. What is patient and family centred care.   
• The Beryl Institute. Defining Patient Experience.   
• World Health Organization Secretariat. Framework on Integrated, People-Centred Health Services. World Health Organization; 2016. https://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1&ua=1.