Archive:
Monday, January 30, 2017 at 10:00 am MST / 12:00 pm EST
Purpose of the Call:
"…if I apply
this [framework] conceptually to any problem I've got in safety I can make it work, and it orders my thinking" – Neil Prentice, Assistant Medical Director Mental Health, Tayside Trust, Scotland
In Canada, as in the UK and US the focus of governments on assessing both quality and safety has increased over the past 10 years.[1],[2] A very large number of quality outcomes have been specified but the approach to safety has been much narrower, leaving many aspects of safety unexplored.[3] The measurement of harm, so important in the evolution of patient safety, has been largely neglected[4] and there have been prominent calls for improved measures.[5] There is a critical need for patient safety measurement at the front lines, so that clinical teams can focus on key problems. Don Berwick has stated that 'most health care organisations at present have very little capacity to analyse, monitor, or learn from safety and quality information. This gap is costly and should be closed. Early warning signals can be valued and should be maintained and heeded'.5,[7] In 2013 Professors Charles Vincent, Susan Burnett and Jane Carthey published their report
The Measuring and Monitoring of Safety[8] which describes their framework to be implemented in practice to close the gap identified by Berwick.
The framework provides a broader view of the information needed to create and sustain safer care.
Objectives:
- Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
- Describe how the framework would work in Canada
Resources:
Speaker Biographies
Professor Charles Vincent
Professor Charles Vincent is trained as a clinical psychologist and has worked in the British NHS for several years. Since 1985 he has focused on conducting research on the causes of harm to patients, the consequences for patients and staff and methods of improving the safety of healthcare. He established the Clinical Risk Unit at the Department of Psychology, University College London where he was Professor of Psychology. In 2002 he moved to become Professor of Clinical Safety Research in the Department of Surgery and Cancer at Imperial College in 2002. From 1999 to 2003 he was a Commissioner on the UK Commission for Health Improvement. He has acted as an advisor on patient safety in many inquiries and committees including the Bristol Inquiry, the Parliamentary Health Select Committee, the Francis Inquiry and the Berwick Review. From 2007 to 2013 he was the Director of the National Institute of Health Research Centre for Patient Safety & Service Quality at Imperial College. He moved to the Department of Experimental Psychology in January 2014 with the support of the Health Foundation to continue his work on safety in healthcare.
G. Ross Baker, Ph.D.
G. Ross Baker, Ph.D., is a professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto and Director of the MSc. Program in Quality Improvement and Patient Safety. Ross is co-lead for a large quality improvement-training program in Ontario, IDEAS (improving and Driving Excellence Across Sectors). Recent research projects include a review and synthesis of evidence on factors linked to high performing healthcare systems, an analysis of why progress on patient safety has been slower than expected and an edited book of case studies on patient engagement strategies.
Chris Power
What began as a desire to help those in need 30 years ago has evolved into a mission to improve the quality of healthcare for all Canadians. Chris Power's journey in healthcare began at the bedside as a front-line nurse. Since then, she has grown into one of the preeminent healthcare executives in Canada. Her experiences, her success, and her values have led her to the position of CEO of the Canadian Patient Safety Institute. Previously, Chris served for eight years as president and CEO of Capital Health, Nova Scotia, with an annual operating budget of approximately $900 million, and 12,000 staff. Under Chris’s leadership Capital Health achieved Accreditation with Exemplary Status in 2014 with recognition for 10 Leading Practices.
SHIFT to Safety
Ensuring patients are safe remains a major challenge for Canadian healthcare organisations and systems. The Canadian Patient Safety Institute's (CPSI) new initiative,
SHIFT to Safety, has been launched to address these challenges, including helping providers and leaders improve their measurement efforts.
References:
[1] Baker, G Ross,
Beyond the quick fix – Strategies for improving patient safety. Institute of Health Policy Management and Evaluation. Nov.9.2015
[2] Darzi A. High quality care for all. London: Department of Health, 2009.
[3] Quality and Outcomes Framework 2013/14. London: Department of Health, 2013.
[4] Vincent CA, Aylin P, Franklin BD, et al.
Is health care getting safer? BMJ 2008;337:1205–07.
[5] Francis R.
Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. London: Department of Health, 2013.
[6] Jha A, Pronovost P.
Toward a safer health care system: The critical need to improve measurement. JAMA. 2016.
[7] Berwick DM.
A promise to learn—a commitment to act. Improving the safety of patients in England. London: Department of Health, 2013
[8] Vincent CA, Burnett S, Carthey C.
The measurement and monitoring of safety in healthcare. London: Health Foundation, 2013
