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CPSI Share                                                    
Leader; Provider
9/10/2020 7:00 AM

Is care safe today?

What are the obstacles to care being safe?

What can we do to mitigate those issues?

Understanding the difference between the absence of harm and the presence of safety is essential: patient safety refers to more than just looking at harm that has occurred in the past. Living the principles of the Measurement and Monitoring of Safety Framework  (MMSF) requires broadening our view of safety by shifting our focus from managing risk to advancing safety.

"Moving from the absence of harm to the presence of safety involves a proactive approach to safety rather than a retrospective past term view," says Wayne Miller, Senior Program Manager at the Canadian Patient Safety Institute (CPSI). "You need to be able to push the envelope around patient safety to advance safe care. It means being thoughtful and deliberate to make the shift in your actions and behaviours. By asking the framework questions, coupled with anticipation preparedness and innovative learning, you are not just waiting to respond, but actually anticipating things that are happening inside the system and taking action on them."

Safety Improvement Project on the Measurement and Monitoring of Safety teams at the Closing Congress
Safety Improvement Project on the Measurement and Monitoring of Safety teams at the Closing Congress

Members of the 11 participating teams from the 18-month Safety Improvement Project for the Measurement and Monitoring of Safety initiative, created environments where staff now anticipate problems and feel empowered to speak up and advocate for their patients.

They have learned how to think about safety in a very different way. They do things that help achieve the presence of safety. A tool adapted from the United Kingdom, called the Safety Measurement and Monitoring Maturity Matrix (SaMMMM) (Carthey J and Downham N; 2017), enables them to self-rate their level of maturity in creating and instilling the presence of safety within their organizations. The Safety Improvement Project teams have created a video to share their learnings.

As Anne Maclaurin, CPSI Senior Program Manager, points out, "Safety is more than metrics. It is more than just counting the past harm that has occurred. By tapping into the wisdom of patients and healthcare providers, the presence of safety will cultivate the thoughtful intelligence that exists in your day-to-day interactions while delivering care. You will add value to the information you are collecting, to what you are seeing, to what you are hearing, and to what you are observing."

"Everyone has something that they can contribute to safety," adds Virginia Flintoft, CPSI Senior Program Manager and MMSF Coach. "Whether you are a point-of-care provider, a leader, or a Board member, there is value in looking at the broader perspective of safety and what you can do to create safety versus preventing harm. Determine what your role is in creating safety; take the time to start shifting your thinking on what safety is; and learn what you can do to in the moment, day-to-day, to create safety. It's about communication, information-sharing, and the willingness to support one another that is really critical. It is changing attitudes and changing the way we approach our work."

A learning session was held in August to discuss and share strategies of how teams have utilized the framework to manage risk in their preparation and response to the COVID pandemic. The session was recorded and is available upon request. A webinar to disseminate the learnings from the Evaluation of the Measurement and Monitoring Safety Improvement Project is being planned for October 14, 2020.

A virtual toolkit of learnings and resources from the Measurement and Monitoring of Safety Demonstration and Safety Improvement Projects is being compiled. It will contain key concepts for each of the domains of the framework, some metrics or indictors of measures, and tools that can help. It will also  include activities that can be used to help bring the framework alive, a video library to draw from, and a list of literature used to strengthen and expand understanding of the concept. We anticipate the final product will be available early in 2021 and will be announced on our website. For the latest information on the Measurement and Monitoring of Safety Framework and to access the video, visit