Provincial and Territorial Organizations
The Government of Alberta has published a five year health action plan released in November 2010. The five main strategies are below with specific references and/or stated actions related to patient safety included:
- Be Healthy, Stay Healthy
- Strengthen Primary Health Care
- Improve Access and Reduce Wait Times
- Provide More Choice for Continuing Care
- Build One Health System
The Alberta Health Act reinforces that the Government of Alberta is committed to the principles of the Canada Health Act. The Alberta Health Act calls for the adoption of a Health Charter. The Health Charter sets out the values that describe the health system Albertans want now and in the future and sets out fundamental expectations and responsibilities within the health system.
Alberta Health Advocates
The Office of the Alberta Health Advocates brings together Alberta's Mental Health Patient Advocate and the new Health Advocate and Seniors' Advocate. It's a place where Albertans can come to for advice and help in dealing with their issues. People will be helped to find their way to the services and patient concerns offices they need.
Alberta Health Services
Alberta Health Services' 2014-2017 Health Plan and Business Plan guides and outlines the organization's operational goals over the next three years based upon three strategic directions:
- Bringing appropriate care to community
- Partnering for better health outcomes
- Achieving health system sustainability
The AHS Quality and Patient Safety Strategic Outline list the following key enablers (each of which is linked to organizational strategies and performance measures):
- Patients as Partners
- Skilled People and a Supportive Culture
- Accountability through Measurement and Evaluation
Health Quality Council of Alberta (HQCA)
The Health Quality Council of Alberta is a provincial agency that pursues opportunities to improve patient safety and health service quality for Albertans. Its work is guided by three core elements: the Health Quality Council of Alberta Act, its Strategic Framework, and the Alberta Quality Matrix for Health. The HQCA’s Strategic Framework defines four strategic areas of focus that align with its ongoing and future projects.
- Build capacity
- Measure to improve
- Monitor the health system
- Partner with the public
HQCA Patient/Family Safety Advisory Panel. The mandate of the HQCA’s Patient/Family Safety Advisory Panel is to identify, study, review, advocate and advise the HQCA on patient safety and quality issues from a citizen, patient, and family perspective. The Panel was established in 2010 to leverage the experiences and perspectives of patients and their families to improve and promote patient safety in Alberta’s health system. It started as a strategic initiative through the provincial Patient Safety Framework for Albertans. Through the HQCA, the Panel works to promote patient safety principles, concepts, and actions in all aspects of Alberta’s publicly-funded healthcare system.
British Columbia Ministry of Health Services
The British Columbia Ministry of Health Services has a 2015-2018 Service Plan with three strategic goals:
- Support the health and well-being of British Columbians
- Deliver a system of responsive and effective health care services across British Columbia
- Ensure value for money
In 2014, the British Columbia Ministry of Health released Setting Priorities for the B.C. Health System that sets out the broad strategy and future direction of the B.C. health care system, including providing patient-centred care as a top priority. The Ministry of Health also released a series of policy papers focused on several key health care priorities, including The B.C. Patient-Centered Care Framework.
BC Patient Safety & Quality Council
The BC Patient Safety & Quality Council has established a strategic plan that sets out the vision, strategic directions and goals for the Council for 2017 to 2020. The plan includes 4 strategic priorities:
- Provide system-wide leadership on quality, in collaboration with stakeholders
- Engaging patients, caregivers and the public as partners in their health care system
- Build capability for health care system transformation and improvement
- Support improvements in the quality of care
Manitoba Health, Seniors and Active Living (MHSAL)
There are several initiatives underway in the health care system to improve patient safety, including making changes to deliver safer care, to better enforce infection prevention and control measures, and to facilitate better communication between health care providers and patients and their families. Manitoba Health, Seniors and Active Living is working collaboratively across all provincial health organizations to encourage, support and enhance patient and public engagement at all levels of the health care system.
The Patient Safety Framework sets out the responsibilities and obligations of the Manitoba health system related to patient safety. The Regional Health Authority Act of Manitoba makes mandatory the establishment of Local Health Involvement Groups to ensure community/patient input into local health services.
Manitoba Institute for Patient Safety (MIPS)
In 2004, the Manitoba government established the Manitoba Institute for Patient Safety (MIPS). This independent, non-profit organization promotes and co-ordinates activities to promote and enhance patient safety in Manitoban. MIPS has worked for a decade to encourage patients to have a voice in their healthcare, and have promoted that systems and providers hear that voice. The board's "Declaration of Patient and Family Engagement in Patient Safety" is the foundation of our work in education, resource development and promotion, raising awareness of patient safety, and advice on policy and legislation.
Operational objectives for 2017-18 are:
- Enhance knowledge of patient safety culture with governors, healthcare organizations, and healthcare providers.
- Promote self-advocacy with patients, families and the public for their safe healthcare.
- Foster healthcare partnerships with patients, families, and healthcare providers.
Newfoundland and Labrador
Department of Health and Community Services
The three strategic priorities are outlined below.
- Population Health
- Enhanced legislative and policy frameworks
- Improved capacity building initiatives in the population health system
- Implemented public awareness initiatives towards improving population health
- Increased collaboration and stakeholder engagement to advance and inform initiatives in key areas of population health
- Access to Priority Service
- Quality of Care and Efficiency
Government of New Brunswick
The province published a provincial health plan called "Rebuilding Health Care Together: The Provincial Health Plan 2013-2018." The goal of the health plan is to build a long-term sustainable, effective and efficient health-care system. The plan is based on seven principles for re-building the provincial health system:
- Access: The ability of patients or clients to obtain the right care or service at the right place and the right time, based on respective needs, in the official language of their choice;
- Appropriate Range of Services: The care or service provided is relevant to the patients' or clients' needs and based on established standards;
- Effective: The care, service, intervention or action achieves the desired results;
- Efficient: Achieving the desired results with the most cost-effective use of resources;
- Equitable: Aiming for equitable care and services for all;
- Safe: Potential risks of an intervention or the environment are avoided or minimized;
- Clinically Sustainable: Programs include at least four or five providers, with sufficient volume to maintain clinical expertise.
New Brunswick Health Council (NBHC)
The New Brunswick Health Council has a dual mandate of engaging citizens and reporting on health system performance. The main areas of focus are the following:
- Population health: What is the health status of the population?
- Quality of services: How effective are health services?
- Sustainability: Is the health system sustainable?
The New Brunswick Health Council fosters transparency, engagement, and accountability by:
- Engaging citizens in a meaningful dialogue.
- Measuring, monitoring, and evaluating population health and health service quality.
- Informing citizens on health system's performance.
- Conduct care experience surveys (home care 2012; acute care 2013; and primary health survey 2014 to assess progress from baseline results three years ago); and compile and disseminate system report cards.
- Launch and support public website with population health snapshots provincially and by health zone: My Community at a Glance.
Northwest Territories (NWT)
The NWT Department of Health and Social Services has published a 2011-2016 Strategic Plan. The plan outlines six key priorities for the territory:
- Enhance services for children and families
- Improve the health status of the population
- Deliver core community health and social services through innovative service delivery
- Ensure one territorial integrated system with local delivery
- Ensure patient/client safety and system quality
- Outcomes of health and social services are measured, assessed and publicly reported
The NWT Health and Social Services Performance Measurement Framework (the Framework) was published in May 2015 as well as the Public Performance Measures Report 2015 (the Report). The Framework is the first in Canada to incorporate both health services and social services into one comprehensive framework. Within the Framework the system outcomes that fall under the system goal "Best Care" include: patient/client centred, culturally relevant, appropriate, accessible, effective, efficient, and safe. The Report is intended to track and measure the performance of the NWT HSS system as it relates to improving the overall health status of the NWT. The 2015 Report does not include indicators specifically related to patient safety.
The Nova Scotia Department of Health and Wellness has the following four strategic goals included in the 2015-16 Statement of Mandate :
- Health of the Population - Improve the health and wellness of Nova Scotians through health promotion, disease and injury prevention, enhanced primary health care and culturally competent chronic disease management.
- Health System Workforce - A workplace culture that fosters leadership, competence, collaboration and engagement.
- Experience of Care - Access to quality, evidence‐informed, appropriate care. The two 2015-16 priority areas for action under this strategic goal are:
- More coordinated team‐based primary care, giving patients comprehensive non‐acute services from practitioners, such as doctors, nurses, nurse practitioners, dieticians and physiotherapists
- Increased use of evidence and data to inform planning and system learning to improve safety and service delivery
- Resource Stewardship - Sustainable actions that support learning, research, innovation and effective use of resources
Ministry of Health and Long Term Care (MOHLTC)
In Ontario, two initiatives are currently underway that will support the government's commitment, as articulated in the Patients First Act, 2016, to strengthen the voices of patients and families in their own health care planning :
Minister’s Patient and Family Advisory Council
As part of Ontario’s Open Government commitment and the Patients First: Action Plan for Health Care, the ministry is committed to further expanding patient engagement in Ontario by creating a Minister’s Patient and Family Advisory Council (PFAC) that will provide advice to the Minister of Health and Long-Term Care on key priority health care issues. The Council will be comprised of patients, families, and caregivers, who will share their health care needs and concerns and provide valuable insight into the policy development process. The Minister’s PFAC has a mandate to provide advice to the Minister on:
- Implementation planning for reforms set out in the Patients First: A Proposal to Strengthen Patient-Centered Health Care in Ontario Discussion Paper;
- Implementation of a provincial approach to patient engagement on priority initiatives identified by the Ministry; and
- Other issues or trends impacting patients, as requested by the Ministry
Local Health Integration Network’s Patient and Family Advisory Committees
An important component of the Patients First Act, 2016 is that it established the requirement that each of the 14 Local Health Integration Networks (LHIN) strengthen the patient voice in health care planning by creating one or more Patient and Family Advisory Committees (PFACs) within their respective regions. These patient advisory committees are being established to:
- Improve communication between patients, families, and the LHINs
- Facilitate improved patient experiences of care
- Foster patient involvement in care delivery
Health Quality Ontario
Health Quality Ontario is the provincial advisor on the quality of care, and puts people with lived experience at the centre of its quality mandate. This is captured in Health Quality Ontario's 2016 Strategic Plan, which highlights five priorities:
- Providing system-level leadership for health care quality
- Increasing the availability of information to enable better decisions
- Evaluating promising innovations and practices, and supporting broad uptake of those that provide good value for money
- Engaging patients in improving care
- Enhancing quality when patients transition between different types or settings of care
* Note: patients at Health Quality Ontario refers to people cared for in hospitals, residents living in long-term care homes, people being cared for at home and through community programs, families and other caregivers.
Health Quality Ontario ensures patients are embedded throughout its work, bringing the voices and perspectives of those with lived experience to the forefront in improving health care quality. It also reports publicly on quality indicators related to patient safety, experience and satisfaction, and supports patients, caregivers and health professionals across Ontario in engaging with each other. Their website is just one example of how Health Quality Ontario spreads patient engagement best practices, with its curated hub of tools and resources to support engagement efforts.
Registered Nurses' Association of Ontario (RNAO)
RNAO is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve.
The purpose of this Best Practice Guideline is to promote the evidence-based practices associated with person- and family-centred care, and to help nurses and other healthcare providers acquire the knowledge and skills necessary to become more adept at practising person- and family-centred care.
Ontario Hospital Association (OHA)
OHA 2013-2017 Strategic Plan: A Catalyst for Change, outlines three strategic directions for the organization as well as set of OHA performance indicators they will use to measure their own progress. The three strategic directions are:
- Advancing Integrated Care with the goal to achieve a seamless patient experience.
- Realizing Quality with the goal to advance high quality patient care.
- Delivering value with the goal to drive system performance.
The OHA is a key resource for Ontario hospitals that function within an increasingly complex legislative framework for quality and patient safety in Ontario where many Acts intersect with one another. The OHA has developed a number of backgrounders, updates, submissions, FAQs and toolkits, all designed to provide relevant and timely information on legislative and regulatory issues.
Cancer Care Ontario
Cancer Care Ontario (CCO) commenced its person-centred care journey is 2010. Quality of life and patient experience continues to be one of the primary pillars in the Ontario Cancer Plan IV, a strategic document which informs CCO's goals and priorities in cancer care as well as those of the 14 Regional Cancer Centres in Ontario. In addition, in 2015 CCO developed a Person Centred Care Guideline, which sets the standard of care that people experiencing cancer (i.e., patients, family members, and carers) in Ontario should expect to receive. This guideline is a foundational step forward to advancing a person-centred approach to care delivery and to improving the patient experience across Ontario. Another valuable resource is the Patient and Family Advisory Council Toolkit structured around creating and maintaining a patient and family advisory council.
Prince Edward Island (PEI)
Health PEI is Prince Edward Island's single provincial health authority. Health PEI is responsible for the delivery and management of all PEI health services. Health PEI has published a 3 year Strategic Plan outlining the health system direction for 2013-2016. This Strategic Plan has 3 areas of focus:
- Ensuring appropriate patient safety standards are met
- Embedding patient centered care
- Promoting improved health outcomes through prevention and education
- Fostering a healthy work environment
Health PEI Quality and Safety Committee is a subcommittee of the Health PEI Board of Directors. This committee includes two public members. The Committee meets several times each year to receive reports from 19 provincial quality teams. These teams are monitoring quality and performance measures across all aspects of the health system. Resources to engage in patient safety and much more are available on their website.
Ministère de la santé et des services sociaux (Ministry of Health and Social Services)
The 2015-2020 Strategic Plan of the Ministry of Health and Social Services, submitted to the National Assembly, is part of Results-based Management, established by the Public Administration Act. It sets out the strategic choices that the Ministry and the health and social services network are committed to achieving over the next five years through priorities for actions based on realistic objectives, indicators and targets, which will achieve the expected results in 2020.
Among the stated principles on which the Ministry relies, the MSSS names the "Partnership with users". This principle stipulates that users "want to preserve their autonomy, be involved in their care and services, and be part of the health and social services system". According to the Ministry, the establishment of a genuine partnership between the users and the various actors in the system can lead to better health outcomes and contribute to improving the quality of care and services, user safety and control of health care costs.
In addition, the 2016-2017 Action Plan of the Cancerology Branch, developed in accordance with the 2015-2020 Strategic Plan of the Ministry of Health and Social Services, includes all the priority actions to be carried out in the next year in order to improve the survival of those affected by cancer and their quality of life through the provision of accessible and efficient health care and services adapted to the needs of users. One of the expected results of their five areas of improvement is: the establishment of a national committee networking all representatives of cancer patients who sit on the institutional cancer coordination committees.
Similarly, in mental health, one of the values represented in the 2005-2010 Mental Health Action Plan recognizes "partnership with members of the entourage as partners in organizing, planning and provision of services, as well as the full exercise of the citizenship of sick persons, including those with a mental disorder ". Per the action plan, members of the entourage must be supported in their involvement and participation by the organization.
Institut National d'Évaluation en Santé et Services Sociaux (INESSS)
In its strategic plan and orientations 2016-2020, the Institut National d'Évaluation en Santé et Services Sociaux is engaged in the integration of patients, users, and their families and the public's participation in the process of scientific knowledge production, from innovation to evaluation activities. This new vision of public participation is based on the idea that co-production of knowledge is a collaboration between clinical settings, research teams, health care management settings and patients and public through their experiential knowledge. Patients and public participation is more and more integrated in the identification of health priorities and within different evaluation projects. INESSS has recently structured an approach to facilitate patients, users, and the public's participation in INESSS governance structures and committees and different evaluation projects. Patients and the public have been implicated or are currently involved in different projects as experts (within committee of experts) or as stakeholders (within stakeholder's committees). Moreover, field surveys and consultation activities are launched to document the perspective of patients and the public on several field (for instance, in drugs evaluation process).
Commissaire à la santé et au bien-être (Health and Welfare Commissioner)
On March 16, 2017, the Health and Welfare Commissioner (HWC) published an evaluation report entitled "The Performance of Québec's Health and Social Services System" (La performance du système de santé et de services sociaux québécois). In this report, more than 200 indicators were used to assess the performance of the system. The HWC included a range of indicators in connection with Humanization, including indicators related to patient engagement: "Patient involvement in decision-making", in other words, the integration of the patient and his or her family members into care decisions and relevant services (ex.: proportion of people who report having always been involved as much as they wanted in decisions about treatment and their care).
Other indicators in this category include: 1) Communication and listening: Listening to the patient, his or her experience, emotions, expectations (ex.: proportion of people who report receiving enough information about their care); 2) Respect: Providing care with courtesy and cordiality (ex.: time spent on a patient during a routine visit).
In 2014, the Health and Welfare Commissioner called for a Citizen Forum with a mandate of three years. The Forum is composed of 25 members: 16 citizens from different regions of Quebec and 9 citizens with a particular set of expertise in relation to health and social services.
The Forum's mandate is to provide the HWC with perspectives on a variety of issues of common interest to our health and social services system and, more generally, to the health and well-being of the public. For example, the previous Forum addressed issues related to chronic diseases, perinatal and early childhood, as well as prenatal screening for Down syndrome. The HWC's post-Forum reports can be accessed via the following link (http://www.csbe.gouv.qc.ca/publications.html).
Three to four times a year, the Forum members meet for about two days to deliberate on various issues. Members are not remunerated, but expenses incurred in the performance of their duties, such as accommodation, transportation and meals, are reimbursed at the applicable government rates. The Commissioner determines the mode of operation of the Consultation Forum, and each member receives a copy of the document that refers to it. A code of ethics establishes the principles and rules of ethics of the members of the Forum.
Also, on October 6, 2016, the HWC released the Thematic Appraisal Report on the Performance of the Health and Social Services System 2016 (Rapport d'appréciation thématique de la performance du système de santé et de services sociaux 2016) - "A State of Play: Hearing the Citizen's Voice to Improve the Provision of Care and Services" (Un état des lieux : Entendre la voix citoyenne pour améliorer l'offre de soins et services). In this report, the Commissioner conducted a structured consultation, which focused on presenting the citizen's perspective and ethical issues related to the provision of health and social services by the state so that decision-makers could integrate these elements, which are essential to the decision-making.
This broad public consultation has made it possible to highlight three goals widely valued by Quebec citizens: 1) to consider health and well-being as a collective resource and a fundamental right to preserve without concession; 2) truly put the person, his or her needs and those of his or her family members at the center of services and decisions; 3) safeguarding a universal, "free" public system that is an element of collective pride and a strong commitment to citizenship.
At the moment, the CSBE is in a difficult situation and its activity might be transferred to another organization in Québec
Ministry of Health and Health System
The 2015-16 Health Plan for the Ministry of Health and Health System is organized by four strategies: Better Health, Better Care, Better Value, and Better Teams. The plan outlines overall Government goals, Ministry goals, strategies and performance measures. Patient safety related content in the plan is highlighted below:
- Improve population health through health promotion, protection and disease prevention, and collaborating with communities and different government organizations to close the health disparity gap.
- In partnership with patients and families, improve the individual's experience, achieve timely access and continuously improve healthcare safety
- Build safe, supportive and quality workplaces that support patient and family-centred care and collaborative practices, and develop a highly skilled, professional and diverse workforce that has a sufficient number and mix of service providers
Patient and Family Advisor Program. As part of its Patient First commitment, the Ministry of Health has developed a Patient and Family Advisor (PFA) program to actively engage patients and families in its own work, including development, implementation and evaluation of health system policies and programs. The move follows the development of a framework for patient- and family-centred care, to provide direction for the Saskatchewan health system. The concept was a key recommendation by Patient First Review Commissioner Tony Dagnone whose 2009 report recommended that "the health system make patient- and family-centred care (PFCC) the foundation and principal aim of the Saskatchewan health system".
Putting Patients First (SK). The Patient First Review report For Patients' Sake recommended that "the Saskatchewan healthcare system make patient- and family centred care (PFCC) the foundation and principle aim of the Saskatchewan health system through a broad policy framework to be adopted system wide". In response to this recommendation, a provincial framework for patient- and family-centred care was developed in consultation with health system stakeholders as well as patient and family advisors from the Saskatoon Health Region. The framework has been shared with stakeholders to guide their adoption of patient- and family-centred care. As indicated in the 2011-12 Strategic and Operational Directions for the Health Sector, patient- and family-centred care is a priority for the Saskatchewan health system, and the Saskatchewan health system is committed to moving forward with patient and family-centred care collectively as a system to improve the patient experience across the care continuum.
Health Quality Council (HQC)
The Saskatchewan Health Quality Council (HQC), 2016-2019 Strategic Plan highlights four specific priorities the organization will focus on over the coming year that reflect their core mandate.
- Integrate patients and families as partners in all aspects of healthcare
- Build learning systems to spread knowledge on improving health care quality and safety
- Measure health care outcomes and processes to generate evidence for decision-making
- Drive improvements in quality and safety by spreading best practices, ideas and insights.
Online resources available at hqc.sk.ca
The Yukon Government has a Health and Social Services Strategic Plan for 2014-2019. The Departmental Goals are:
- Optimal physical and mental wellbeing
- Safety and wellbeing for vulnerable/'hard-to-serve' populations
- Access to integrated, quality services