Principles

The board can support their organization’s journey to change culture to support quality and patient safety.

Board Commitment to Transparency and Accountability

•  Boards can showcase leadership and commitment to quality and safety through public demonstrations and ongoing commitment to quality initiatives. For example, the Saskatoon Health Region (SHR) board holds two meetings per month, one which is public and open to community and media attendees, and one in private. All motions must be proposed and passed at public meetings, with minutes posted on the SHR website. At private meetings, the first agenda item is a brief story of a patients’ experience with SHR.
•  Boards can demonstrate commitment to public accountability and transparency by posting meeting agendas, minutes and other materials from board meetings online.
• The Agence de la santé et le services sociaux de-la Capitale Nationale in Québec City has a list of board resolutions, classified by year, and passed over the last decade, on their website.
• The Winnipeg Regional Health Authority board agendas and minutes are available from 2005 on their website.

Involving Patients and their Families

•  Involving patients and families appropriately to share stories and put a human face on safety and quality issues can help change the culture at an organization away from shame and blame towards open discussion and learning from quality and safety issues.
• Patients for Patient Safety Canada is a national network of patient safety champions advocating for improvements in patient safety at local, provincial/territorial, national and international levels.

Organizational Journey to a Just Culture

•  Participation in Safer Healthcare Now! interventions can support a culture of quality and safety. Safer Healthcare Now! is aimed at improving the safety of patient care in Canada through learning, sharing and implementing interventions that are known to reduce avoidable adverse events.
• Data, protocols, tools and information are all important in making patient care safer and more effective, but culture trumps all of these factors.
•  The National Steering Committee on Patient Safety (whose recommendations lead to the creation of the Canadian Patient Safety Institute) recommended that healthcare provider organizations adopt “non-punitive reporting policies within a quality-improvement framework across the health-care system”.
• This recommendation suggests that “the healthcare system must develop an atmosphere of trust, in which openness and frankness in identifying and reporting problems, or potential problems, is encouraged and rewarded.”
•  The Board can also participate in patient safety walkarounds, which expose senior leaders to the front lines of the organization and help build trust and understanding. 
•  In British Columbia, the chairperson of the quality committee for the Provincial Health Services Authority participates in safety walkarounds.
•  The Canadian Medical Protective Association suggests that the use of the term “just” reflects a fair and supportive system. The following are important elements:
• The main focus of analysis of safety issues is on system failures. These are identified and to the extent possible corrected.
• The organization accepts appropriate responsibility and accountability. Individuals are not held accountable for system failures over which they have little or no control.
• Healthcare providers are able to trust that the initial responses to the adverse event, as well as any subsequent analyses and proceedings, will be conducted with fairness, within the legislative and legal frameworks, and in accordance with established hospital policy and/or bylaws. The rights of all individuals, including patients, are protected.
• The relevant policies and procedures to support quality improvement are understood by providers and followed by leadership/management.
• Providers are confident of the organization’s response to an adverse event, which appropriately protects quality improvement information from legal, regulatory or other proceedings.
• The organization does not tolerate intentionally unsafe actions, reckless actions, disregard for the welfare of patients or staff, or other willful misconduct and misbehaviour.
• There is “a collective understanding of where the line should be drawn between blameless and blameworthy actions.”
• Disclosure of adverse events to patients is important. Patients are provided factual information about an adverse event.
• Providers are appropriately supported, protected and educated.
•  Each organization has a ‘quality journey’, slides show one organizations journey – St. Joseph’s Hospital Hamilton (From Boardroom to Bedside, PowerPoint Presentation, Michael Heenan)