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12/22/2014 5:00 PM

Maura Davies is Acting CEO of CPSI. Below are the comments she made at the Canadian Patient Safety Institute’s Annual General Meeting December 5, 2014.

Hugh has spoken eloquently about his vision for the future of healthcare, a vision that captures many elements of a transformed system. I share that vision and wish to also share with you some additional thoughts.
 
As some of you may know, a week ago I stepped down as President and CEO of the Saskatoon Health Region, a position I held for almost 10 years. That transition has given me an opportunity to pause and reflect on the changes that have occurred both in my region and in the Canadian health care system, and to ponder on what lies ahead.
 
The future I envision for health care in Canada holds enormous promise. It is also involves significant risks. I will elaborate a bit, using the SWOT framework with which most of us are very familiar.

Strengths:

I have just returned from visiting my oldest son in Boston, where inevitably there is lively discussion with family and friends regarding the differences between the Canadian and American health systems. My daughter-in -law, Abbie, is a psychiatrist at the Massachusetts General Hospital, which was recently rated as having the best psychiatric program in the USA. When my newest little granddaughter needed medical attention, I was relieved to know that she had access to some of the best pediatric specialists in the country. But I am also conscious that those resources are not readily available to many Americans. Even when a family has good health care coverage, as Ryan and Abbie do, there is still a significant uninsured component, which is a barrier to many people. I am always proud to explain that in Canada we do not need a half dozen staff in our emergency department just to process insurance claims, and that our health card gives us universal access to a wide range of insured health services.

In the future, I see us continuing to cherish our publicly funded system, while being more open to partnerships with the private sector, some of whom have already demonstrated that they can provide high quality, cost effective services within our publicly FUNDED system. I also anticipate that the range of publicly funded services will need to be broadened, to remove the perverse incentives that encourage over-utilization of hospitals and long term care facilities, because many people are unable to access or unable to pay for care in alternative settings. As we are more innovative in how we view all the component parts as a single integrated system, it will be important to ensure that we establish safer mechanisms for transitions of care, enabled by integrated information systems.

Weaknesses:

I am encouraged by the progress we have made in making patient safety a priority, as profiled in the recent 10 year anniversary of CPSI. It is impressive to visit hospitals, long term care facilities, and other health services which have adopted, as part of their standard work, a range of evidence best practices that were not common 10 years ago. I believe the partnership between CPSI and Accreditation Canada has played a significant role in the wide adoption of surgical safety checklists, medication reconciliation, falls prevention programs, enhanced infection control and other quality practices. This is all good BUT...we need to do even better. As a CEO, I was dismayed to see the all too common reports of how we harmed patients. We are still a long way from having zero tolerance for harm to either patients or care providers, a culture that exists in high reliability systems. Even in some of the best health systems in Canada, staff surveys tell us that we have not yet developed a safety culture where staff feel safe to report adverse events and the organization has robust systems in place to promote organizational learning and safer care.

In the future, I hope to see even more learning from other industries. I hope to see greater sharing among organizations about safety issues and leading practices to avoid harm, for example by having all provinces and territories, not just a few, participate in the CPSI Global Safety Alerts. And we need to build upon some good work already underway in various organizations to encourage and support physicians, staff, patients, families and members of the public to report adverse eventss and good catches so we can learn from them and demonstrate our commitment to a safety culture.

Opportunities:

The Canadian health care system is blessed with a highly educated, dedicated workforce, people who choose to work in health care because they want to help people and make a difference to their community. For them, it is not just a job, it is a calling. As pressure continues to grow on our health systems, in part because of changing demographics and consumer expectations, there is an enormous need and opportunity to optimize the human capital we have. This will require significant changes to funding models for physicians and collaboration with unions to overcome silos and turf protection. It will require different leadership models, which truly engage point of care providers in problem solving, with leaders as coaches and enablers.

I often remember visiting the Boeing plant in Seattle, as part of my lean training, and asking a young Boeing employee what his job was. I was dumbfounded when he proudly told me he "solves problems" . Imagine the potential if every person working in health care had that same job description! And even more, imagine the power if we truly engaged patients and families as partners in care, working with health professionals to achieve better health and better care for themselves and their loved ones.

Threats:

We could probably spend all day sharing our dreams and aspirations for our health care in Canada. But we should not be naive. That future state will not be achieved if we ignore the all too real threats associated with the rising cost of health care, the increasing politicization of our health system, and the frustration many patients, families and care providers feel about our current system. My thoughts on this are inevitably coloured by my experience in Saskatchewan, where discussion about the province's adoption of lean, the quality of seniors care and aging facilities has dominated the debate in the legislature and media and where a recent provincial survey of staff and physicians revealed disturbingly low levels of engagement. As system leaders, we cannot ignore those threats. We need to work with our political colleagues to help them make informed policy and funding decisions. We need to get to the root cause of disengagement and learn from those organizations which have highly satisfied and engaged staff and physicians. We need to be courageous and innovative to ensure sustainability of the health system we cherish and want to improve.
 
As I left Saskatoon Health Region and as I step down as a member of the CPSI board, I know I am ten years older. I think I may even be a bit wiser. That wisdom tells me we need to move beyond the rhetoric and commit to concrete action. I am very encouraged by the initial work that has been done by CPSI and many other partners, some of whom are represented here today, in developing an action plan to enhance patient safety and the quality of healthcare in Canada. It is my hope that this plan will be fully implemented, so that five years from now we will be able to demonstrate that we have built on our strengths, addressed at least some of our major weaknesses, leveraged the opportunities and overcome existing threats, to ensure our Canadian health system remains one we are proud of and sustainable for future generations.