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​​​​​The work of the Canadian Patient Safety Institute was on full display in Texas recently as Ioana Popescu, Patient Safety Improvement Lead, shared her experiences with Patients for Patient Safety Canada, Incident Management, Safe Surgery and Hand Hygiene at the 8th Institute for High Reliability Organizing (HRO) conference hosted by the University of North Texas Health Science Center in March 2014.

In healthcare, many organizations aspire to be highly reliable with predictable, safe, and effective operations. This is reflected in their organizational design which includes tangible structures, procedures, incentives, as well as intangible aspects like culture and communications, all crucial to safety.

HRO panel.jpg 

There is no single design that is “safe” or “best” for all organizations and all times; rather, clinicians and managers must design and redesign for their organizations at different organizational stages. Designing to achieve goals that appear to be in conflict, such as safety and cost, can be opportunities to understand more deeply and improve systems of care.

Ioana was a member of the inaugural panel at the conference in the company of Dr. Jim Conway, E-patient Dave and Dr. Bruce Spurlock. The goal of the panel was to discuss how to bring these principles to the healthcare-patient interaction and to the patient and patient’s social contacts.

Patients for Patient Safety Canada members contributed to Ioana’s presentation by submitting their experiences and ideas via email. They believe that patients and families have a role to play however we need to be aware that in some situations patients/families are too worried about the illness to participate therefore patient advisors, who represent the voice of past and future patients, should be engaged in designing reliable systems. They also highlighted examples of successful engagement like the Jewish General Hospital’s Speak-up and Listen-up campaign which targets both patients/families and providers.

Recognizing that this topic is new and there isn’t enough research and evidence around it, they started the session by engaging the participants in a dynamic conversation on ways in which patients and families can contribute to reliability across the continuum. Here are a few pearls from the group of around 30 participants:

  • We shouldn’t focus on teaching HRO to patients and families but rather on mutual empathy;
  • The focus on compliance or standards should switch to achieving the health goals;
  • It’s important to be mindful and change the mindsets of both providers and patients and families so they can participate;
  • Motivational interviewing techniques can be helpful;
  • Balancing staff safety and patient engagement it is an important consideration especially in some units like emergency and intensive care; 
  • Understanding the social and cultural needs of each patient is important for achieving health objectives (e.g. social stigma);
  • Celebrate successes and anticipate the next solution;
  • Find innovative solutions (e.g. put pressure cuffs in barber shops).

HRO with the patients/ families/ customers/ public is a topic that needs to be explored further because it can help make care safer faster. Please share your examples and stories – from healthcare and outside – by emailing Ioana at  

Jim Conway’s blog pre-conference: 

E-patient Dave blog: 

The agenda and presentations are available here: