Day 1 of Canada's Virtual Forum on Patient Safety and Quality Improvement was all about the past, present and future of Safer Healthcare Now! Here's our recap of the day.

The day began with Christina Gunther-Murphy from the Institute for Healthcare Improvement (IHI), and Mike Cass from the Canadian Patient Safety Institute (CPSI) talking about the origins of Safer Healthcare Now! (SHN). IHI's mission is to improve health and healthcare worldwide and their goal is to tell the story of various organizations that are working really hard to minimize harm in healthcare. They consider unnecessary harm and adverse events outside of death.  SHN was the first organization to bring IHI's 100,000 Lives campaign to an international platform. SHN came forward to IHI and thought about how to bring it to Canada and to share ideas with each other. After that, many campaigns internationally joined to start similar initiatives.

Mike Cass talked about how patient safety was a foreign concept at the front line in 2005. Clinical science and improvement science were not considered equally valid by the frontline. Evidence of unnecessary harm continued to accumulate and organizations were compelled to sign up for the new SHN initiative. Pushback was greater than expected but over time the initiative was accepted as a valuable resource. Staff now view it as an essential part of a healthy workplace and part of the hospital's promise to patient safety.

Next came two of the more influential voices on patient safety in Canada – Drs. Ross Baker and Peter Norton. They talked about how SHN is the largest quality or patient safety initiative ever launched in this country that engaged a large number of teams, with some notable results. There are definitely 'hot spots' of improvement, however the evidence is mixed as to sustained improvement across the country.

The big challenges to move patient safety forward in Canada are:

• Efficient use of collaboratives to reach beyond the local level.
• How do we sustain improvement once it happens?
• How can scale up improvements across institutions, regions, provinces and the country?
• Focus more energy on context and its improvement especially at the microsystem level.

The next presenter was Polly Stevens from the Healthcare Insurance Reciprocal of Canada (HIROC), articulating that one of the most significant risks in healthcare is failing to identify and respond to the deteriorating patient condition. HIROC developed a risk ranking process, risk reference sheets on leading practices to address the top risks and pushed out risk assessment checklists to help organizations identify specific opportunities for improvement. Over the past three years, HIROC has seen a steady improvement in the implementation of practices to reduce the risk of failing to identify and respond to the deteriorating patient condition.

Polly Stevens was followed by a panel discussing the impact SHN has had on the front line.

Dawn Hollohan of the Nova Scotia Health Authority spoke about the role of measurement in SHN interventions. She eloquently expressed that measurement is not the goal, improvement is the goal. Dr. Olavo Fernandes shared his "Top 10: How did SHN support organizations to reduce harm and advance meaningful local and national patient safety improvement?" Rosalie Freund-Heritage spoke about the development of the falls prevention audit tool. Meaningful impact of this work has included a tool that is useful for all sectors, supports organizations to meet Accreditation Canada's Required Organizational Practice requirements and the value in benchmarking.

Up next was CPSI CEO Chris Power and CPSI Senior Director of Safety Improvement and Innovation, shedding light on SHN's future direction. They spoke about the comprehensive process that was undertaken to reflect on the success of the first 10 years of SHN and to look forward to what SHN needs to become to help effect transformational change in patient safety across Canada.

Through this process, CPSI heard that people wanted a program that is:

• Patient centric and personalized
• Inclusive
• Easy to access and act upon
• Better use of technology
• Integrated (online and offline)
• Customized for care teams across the care continuum
• Credible
• Supporting everyone in the system (patients, family members, providers, and leaders)

The unifying elements across the new SHN program are: how do I prevent harm from happening, how do I respond to harm that has already occurred and, how do I learn from harm?

CPSI will be ready to launch new SHN next summer. Email info@saferhealthcarenow.com to learn more about how you can get involved in developing the program.

Next up was Jody Hales from the Red Cross talking about an increased acuity, frailty, and needs and expectations of patients and families. As an organization, they want to influence and lead change, and not just respond to change by embedding a learning culture in all they do. There are a number of drivers for this organizational strategy, including the Accreditation Canada process which engages all levels of the system, includes clients/families and is continuous and cyclical.

Kimbalin Kelly and Cameron McAlpine from the Ontario Chiropractic Association were next on stage. They spoke about key criteria for success in engaging people in change including understanding the audience and their different incentives and changing the approach based on that knowledge. People are mobilized by empowering and give capacity to effect outcome. There is a real difference between instructing and engaging. Programs need to evolve in real time as new opportunities arise. The engagement drivers are purpose, agency (capacity to effect change) and incentive and the enabler is credible leadership.

In order to engage people in change you must provide an outstanding experience, understand expectations and aspirations and position the organization to deliver.

Our final presenter delivered the French language session for the day. Dr. Claude LaFlamme offered his reflections of SHN, the program's future direction, and SHN 's surgical care safety initiatives.

If you missed anything or want to re-watch any of these sessions, all of the recordings can be found online.