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Provider; Leader


Patients expect hospital care to be safe and for most people it is. However, a small proportion of patients experience some type of unintended harm as a result of the care they receive. The Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) have collaborated on a body of work to address gaps in measuring harm and to support patient safety improvement efforts in Canadian hospitals. The Hospital Harm Improvement Resource was developed by the Canadian Patient Safety Institute to complement the Hospital Harm measure developed by CIHI. It links measurement and improvement by providing evidence-informed practices that will support patient safety improvement efforts.

The purpose of measuring quality and safety is to improve patient care and optimize patient outcomes. The Hospital Harm measure should be used in conjunction with other sources of information about patient safety, including patient safety reporting and learning systems, chart reviews or audits, Accreditation Canada survey results, patient concerns and clinical quality improvement process measures. Together, this information can inform and optimize improvement initiatives.

The Improvement Resource is a compilation of evidence-informed practices linked to each of the clinical groups within the Hospital Harm measure to help drive changes that will make care safer. Through extensive research and consultation with clinicians, experts and leaders in quality improvement (QI) and patient safety, the Improvement Resource is intended to make information on improving patient safety easily available, so teams spend less time researching and more time optimizing patient care.

The Improvement Resource is a dynamic tool that the Canadian Patient Safety Institute will continue to develop and review every two years, or as new evidence emerge. If you have any suggestions for the Improvement Resource, please send your ideas to

The layout of the Improvement Resource reflects the framework of the Hospital Harm measure (Figure 1) and focuses on actions that can be taken to decrease the likelihood of harm. The measure includes four major categories of harm and within each category is a series of individual clinical groups, or types of harm, each of which connects to evidence-informed practices for improvement.

For each clinical group, the Improvement Resource provides the following:

  • An overview of the clinical group and goal for improvement.
  • Implications for patients experiencing the type of harm and their importance to patients and family.
  • Evidence-informed practices to reduce the likelihood of harm.
  • Outcome and process improvement measures.
  • Associated Accreditation Canada standards and Required Organizational Practices and Global Patient Safety Alerts recommended search terms.
  • Success stories from organizations.
  • References and key resources, including guidelines and select research articles.


As patient safety terminology evolves it is important to be clear on the meaning and differences of specific words. For the purposes of the Hospital Harm measure, the following definitions apply:

  • Harm – An unintended outcome of care that may be prevented with evidence-informed practices and is identified and treated in the same hospital stay.
  • Occurrence of harm – Harmful event is synonymous with occurrence of harm.
  • Patient Safety The reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. An acceptable minimum takes into consideration current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment.
  • Hospital Harm Measure – Acute care hospitalizations with at least one unintended occurrence of harm that could be potentially prevented by implementing known evidence-informed practices.
For harm to be included in the measure, it must meet the following three criteria:
  1. It is identified as having occurred after admission and within the same hospital stay.
  2. It requires treatment or prolongs the patient's hospital stay.
  3. It is one of the conditions from the 31 clinical groups in the Hospital Harm Framework.
Figure 1: Hospital Harm Measure Framework

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