Time to discuss patient safety in health care

Preventable harm is on the rise,

When someone says, “we need to talk,” it's rarely a good sign.

Well, we need to talk about patient safety.

Patient-safety trends have moved in the wrong direction in recent years in Canada and elsewhere.

When we are sick or injured, we turn to the health-care system for help. Most receive safe care, but that's not true for everyone. For instance, new data from the Canadian Institute for Health Information (CIHI) show that one in 17 people admitted to hospital in 2022-23 was unintentionally harmed during their stay. They experienced problems with medications, post-surgery infections, pressure injuries, falls or other issues.

Patient safety has always been important, but the COVID-19 pandemic exposed and exacerbated safety gaps in health care.

Last year was the third year in a row with a rate of potentially preventable harm at or close to six per cent in Canada. That's up from rates of 5.3 and 5.4 per cent in the six years before the pandemic began. The conditions of care and the conditions of work go hand in hand.

Patient safety and the physical and psychological safety of the people who work in health care are deeply intertwined. The pandemic added incredible strain to people who provide care. At the same time, as CIHI data show rates of potentially preventable harm to patients rising, there were higher staff absences, more overtime work and increased use of agency staff to fill gaps.

We need to talk about these tough realities. And, as we move ahead, talking about safety is also an important part of the solution.

That's true for individual patients and families. For example, we've worked with dozens of organizations across the country to improve the safety of care transitions, such as from hospital to home. They introduced discharge summaries designed with patients for patients,

Regular safety conversations allow staff to work together to prevent problems.

used teach-back approaches between patients and health-care providers to ensure care plans and next steps for treatment were clear, actively involved patients and families throughout the process, and had formal plans for post-transition followup.

The result? Both patients and health-care providers report better care-transition experiences, and fewer patients were readmitted to hospital.

It's also true for health-care teams. Regular safety conversations allow staff to work together to prevent problems before they occur.

Research shows that places with positive safety cultures tend to have less patient harm and higher staff satisfaction. Staff from organizations we partnered with to implement regular safety huddles, for instance, looked forward to them as opportunities to come together to proactively discuss how to make care safer for all those involved. They told us that being involved in safety gives meaning to their work and gives value day-to-day.

We can build positive safety cultures at the health-system level, too.

In the past, the focus has usually been on measuring and responding to past harm. But safety is not just about the absence of harm. While we still need to ask how safe care was in the past, we also need to ask whether care is safe today and how it could be safer tomorrow. In doing so, we need to consider all forms of harm — such as over- or under-treatment, delayed or incorrect diagnoses and psychological harm caused by culturally unsafe care — not just physical harm.

Everyone involved in care contributes to safety — patients, families and other care partners, health-care providers and leaders. So we can all be part of building positive safety cultures. To get started, Healthcare Excellence Canada has a free Rethinking Patient Safety Discussion Guide and safety conversation resources for patients and providers.

Now is the time to talk about health-care safety. By redoubling our efforts to promote safety with and for patients and health-care workers, everyone benefits.