Safety Improvement Project for the measurement and monitoring of safety

Last fall, the Canadian Patient Safety Institute launched a safety improvement project (SIP) focused on the Measurement and Monitoring of Safety (MMS).  The SIP builds on the success of the 2017/18 MMS Framework demonstration project led by Dr. Ross Baker at the University of Toronto. Over the next 18-months, 11 participating teams will be supported in rewiring their thinking on patient safety and work within their organizations to foster and promote a new approach to safety. 

"The Measurement and Monitoring of Safety Framework challenges our assumptions in terms of patient safety," says Virginia Flintoft, Senior Project Manager, Canadian Patient Safety Institute. "The Framework helps to shift our thinking away from what has happened in the past, to a new lens and language that moves you from the absence of harm to the presence of safety."

"The Framework changes the nature of the conversation to being more mindful and forward-thinking," says Wayne Miller, Senior Project Manager and lead for the SIP. "We need to shift our approach from one of assurance to inquiry, by changing the focus from past harm to the presence of safety.  We need to understand our past harm but act to enhance safety."

The Measuring and Monitoring of Safety Framework consists of five dimensions that prompt you with a series of key questions to conceptually address any problem you have in safety. These questions move the discussion from assurance to inquiry. The primary questions are:

• Has patient care been safe in the past?
• Are our clinical systems and processes reliable?
• Is our care safe now?
• Will our care be safe in the future?
• Are we responding and improving?
  

St. Joseph's Health Care was one of the eight teams that participated in the 2017/18 MMS demonstration project. This 376-bed teaching hospital located in Toronto, initially introduced the Framework in the Family Birthing Centre (FBC). The 44-bed unit records more than 3,300 births annually. The unit includes a large staff of 75 nurses, 13 obstetricians, 25 midwives, 15 family physicians, four allied health staff and 11 clerical staff.

The Measuring and Monitoring of Safety Framework was used as the backdrop to structure and stimulate discussions and to establish a baseline of the culture of quality improvement in the FBC. Over an eight-month period, there were 285 participants in staff safety huddles, 75 participants in patient and family safety huddles and 49 new ideas generated and initiatives implemented.

A safety board was introduced in the FBC, where staff could record their safety concerns, using a "ticket system".  Staff safety huddles were scheduled twice weekly to discuss safety issues and concerns. A patient safety huddle was held immediately preceding the staff huddle and a summary of patient concerns was shared with the staff. 

"We looked for ways to engage patients in our safety huddles," says Luisa Guerrera, Patient Care Manager, Family Birthing Centre. "Initially, we did not know how to effectively engage patients, but once we figured out the safety huddle framework, we were able to include ongoing participation of a Patient and Family Advisor. Since partnering with patients and families, the nature of our conversations has shifted to more of a solution-focused approach."

St. Joseph's did experience some bumps in the road in terms of sustainability with leadership turnover and trial expansion.  They were able to keep the momentum going through project work, surveys, measurement and monitoring rounds and personal evolutions.

Safety huddles have since been expanded to the NICU twice a week, that has resulted in collaboration with the FBC team on cross-unit safety issues; the ICU has also introduced twice-weekly safety huddles that were triggered by patient-specific safety concerns; and Respiratory Therapy (RT) has created their own safety board and are working with leadership to implement RT safety huddles with an organization-wide lens into safety issues.

"The cultural changes we initially made in the Birthing Centre are now being spread hospital-wide," says Sabrina Encalada, RN.  "We went from a culture of not really asking too many questions, to one where we are looking at how we can prevent safety issues from reoccurring. When we talk about safety now, it seems more team-based, proactive and quality focused."

"The use of this framework has been very helpful in changing the culture at St. Joseph's," says Jelena Sparavalo, Clinical Pharmacist, St. Joseph's Health Centre. "Anecdotally, patients and staff say that they feel safer using this Framework and are able to discuss safety issues in a more proactive way." 

Organizations participating in the Measuring and Monitoring of Safety SIP include teams from Eastern Health – Newfoundland (Remote Patient Monitoring); Nova Scotia Health Authority (Colchester East Hants Hospital); William Osler Hospital – Ontario; Winnipeg Regional Health Authority (Victoria Hospital and Cardiac Sciences Program); Saskatchewan Health Authority (Mental Health and Long Term Care) Alberta Health Services (Seniors – Calgary zone, Central zone and North zone); and Interior Health – British Columbia.

"It is exciting to see the transformation within the teams and their understanding and focus on patient safety," says Anne MacLaurin, CPSI Senior Program Manager. These teams will report out on their work at a closing congress in March 2020.