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Leader; Provider
6/19/2018 6:00 PM

Eight teams from seven healthcare organizations participating in an 11-month demonstration project have reported an improvement in their patient safety culture using the Measuring and Monitoring Safety Framework. The teams say that safety has taken on a whole new meaning and their outlook on safety has evolved. Prior to participating in the Collaborative, many said their staff would bring up issues, but wait for someone else to come up with solutions. Now they are motivated to come up with solutions that they themselves want to implement.

"The Framework is a refreshing way to look at past harm, what is happening currently, and predicting what will happen in the future," says Chris Power, CEO, Canadian Patient Safety Institute. "The participants were on fire. They were so excited about their work and want to be sure that it continues."

The Canadian Patient Safety Institute commissioned Dr. G. Ross Baker and his team at the University of Toronto Institute of Health Policy, Management, and Evaluation to assess implementation of the Framework within the Canadian healthcare context and its impact in measuring and monitoring safety. The demonstration project was supported by the Canadian Patient Safety Institute, British Columbia Patient Safety and Quality Council (BCPSQC), and the Canadian Institute for Health Information.

"The Framework for Measuring and Monitoring Safety helps people rethink their understanding of safety in their own clinical environment," says Dr. Baker. "What we are seeing is that staff are really engaged by this idea that they can have an active role in promoting and maintaining safety."

The Safety and Measurement Monitoring Framework, created by Professor Charles Vincent and colleagues from the Health Foundation, consists of five domains that prompt you with a series of key questions to conceptually address any problem you have in safety. The Framework addresses these dimensions:

PAST HARM: Has patient care been safe in the past?

  • Identify the different types of harm that can exist in your setting
  • Use a range of safety measures, while understanding their strengths and limitations
  • Ensure the measures are valid, reliable and specific

RELIABILITY: Are our clinical systems and processes reliable?

  • Specify the level of reliability you would expect in areas of standardized practice
  • Use local and national audits and initiatives to monitor reliability
  • Understand what contributes to poor reliability


  • Select an appropriate mix of formal and informal safety monitoring mechanisms
  • Use this information to take timely action to avert safety issues
  • Reflect on whether current structures and committees enable timely action to be taken

ANTICIPATION AND PREPAREDNESS: Will care be safe in the future?

  • Don't wait for things to go wrong before trying to improve safety
  • Explore new opportunities to develop systematic ways to anticipate future risks
  • Use a variety of tools and techniques to build an understanding of the factors that give rise to safety issues

INTEGRATION AND LEARNING: Are we responding and improving?

  • Use the incident analysis as a starting point to reveal the wider issues in the system
  • Place more emphasis on learning, feedback and action than simply on data collection
  • Integrate and tailor information to make it meaningful from the ward to the board

"Once you use this tool, it is very powerful," says Aparna Bhattacharjee, McGill University Health Centre. "It can be infused into everything, from the smallest project to a very large endeavor."

"The use of this framework has been very helpful in changing the culture in our organization," says Jelena Sparavalo, St. Joseph's Health Care. "Anecdotally, our patients and staff feel a lot safer using this Framework and being able to discuss safety in a more proactive way."

"The Framework has broadened the way we look at safety," says Sarah Grummisch, Fraser Health. "The biggest accomplishment that we are most proud of is the culture shift. Even though all staff are not aware of the Framework, we have opened up the conversation around safety on the unit with physicians and staff."

Dr. Jane, Carthey, Leading Session Facilitator says, "The Framework has changed the nature of conversations that health teams have about safety. It has made them more mindful, more forward thinking. Before the Framework, healthcare organizations were very entrenched in learning from past harm and did very little in terms of moment by moment of what is happening now and what could happen next."

"The Framework for Measuring and Monitoring Safety is a different way of thinking for us," says Shannon Moore, STARS. "It is more than just thinking about past harm. You can use the key dimensions to look at and think about anything to do with safety and quality improvement."

"The real power of the Framework is the cultural shift and lens of ownership of everyone – on a unit to the Board level," says Colleen Kennedy, BCPSQC.

On April 10, 2018, 40 CEOs and senior leaders attended a round table meeting in Toronto, Ontario. The purpose of the meeting was to spread learnings from the Collaborative and to develop an understanding of the implementation opportunities and challenges of the Framework within the Canadian context, beyond the evaluation sites. There was an overwhelming interest and support to advance the spread of the Framework in Canada.

Click here to access a video where roundtable participants share their views and experiences on the implementation of the Framework.

"The challenge now is to ask the question: how do we spread and scale this up in a way that many more units can be involved?" adds Dr. Baker. "We need to consider that question very closely, because I think it is an important one."