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Quality and Patient Safety Culture


The board has a leadership role in establishing a quality and patient safety culture. Policy, structure, and processes must be in place for patients and family involved in creating a culture supportive of quality and patient safety. At the board level, the culture must support candor, trust, respect and generative discussions. The board must ensure mechanisms are in place for measuring, monitoring, learning, transparency and public accountability.

Tools and Resources

Partnering with Patients and their Families

"Patients are partners in care when they are: supported and encouraged to participate in their own care; in decision making about that care, at the level they choose; and in redesign and quality improvement in ongoing and sustainable ways." (PFPSC member) Involving patients and families appropriately to share their experience and expertise will put a human face on safety and quality issues and help create a patient safety culture.

Organizational Journey to a Just Culture

  1. SHIFTtoSafety
  2. The National Steering Committee on Patient Safety recommended that healthcare provider organizations adopt “non-punitive reporting policies within a quality-improvement framework across the health-care system”. This recommendation suggests that “the healthcare system must develop an atmosphere of trust, in which openness and frankness in identifying and reporting problems, or potential problems, is encouraged and rewarded.”
  3. The Board can also participate in patient safety walkarounds, which expose senior leaders to the front lines of the organization and help build trust and understanding.
    • In British Columbia, the chairperson of the quality committee for the Provincial Health Services Authority participates in safety walkarounds.
  4. The Canadian Medical Protective Association suggests that the use of the term “just” reflects a fair and supportive system. The following are important elements:
    • The main focus of analysis of safety issues is on system failures. These are identified and to the extent possible corrected.
    • The organization accepts appropriate responsibility and accountability. Individuals are not held accountable for system failures over which they have little or no control.
    • Healthcare providers are able to trust that the initial responses to the adverse event, as well as any subsequent analyses and proceedings, will be conducted with fairness, within the legislative and legal frameworks, and in accordance with established hospital policy and/or bylaws. The rights of all individuals, including patients, are protected.
    • The relevant policies and procedures to support quality improvement are understood by providers and followed by leadership/management.
    • Providers are confident of the organization’s response to an adverse event, which appropriately protects quality improvement information from legal, regulatory or other proceedings.
    • The organization does not tolerate intentionally unsafe actions, reckless actions, disregard for the welfare of patients or staff, or other willful misconduct and misbehaviour.
    • There is “a collective understanding of where the line should be drawn between blameless and blameworthy actions.”
    • Disclosure of adverse events to patients is important. Patients are provided factual information about an adverse event.
    • Providers are appropriately supported, protected and educated.