In this resource :

  • Patient Safety Culture Bundle

Enabling 

Organizational priority setting, leadership practices that motivate the pursuit of safety

The Patient Safety Culture “Bundle” is arranged in three main parts with subsections under each; as with other safety bundles, all components (vs. a piecemeal approach) are required to improve patient safety culture. Improving patient safety culture requires sequential, iterative and simultaneous interventions that ENABLE, ENACT and LEARN. 

This section specifically examines the ENABLING components of the Bundle. 

The table below addresses leadership’s responsibility for organizational priority setting and leadership practices that motivate the pursuit of safety. The ENABLING section provides tools and resources to support leadership in establishing organizational priorities; ensuring positive leadership behaviors; appropriate support for human resources and health information technology; and good health system alignment.  

Click the hyperlinked text within the categories to access freely available tools and resources to support your work within this leadership area. 

Organizational priority

Component Link Resource Author Resource Type Resource Title
Board educated, engaged, accountable, prioritizes patient safety http://www.patientsafetyinstitute.ca/en/toolsresources/
governancepatientsafety/pages/default.aspx
CPSI Education Program Effective Governance for Quality and Patient Safety
Board educated, engaged, accountable, prioritizes patient safety https://www.jointcommission.org/assets/1/18/
SEA_57_Safety_Culture_Leadership_0317.pdf
The Joint Commission (2017) Article The essential role of leadership in developing a safety culture
Board educated, engaged, accountable, prioritizes patient safety http://cchl-ccls.ca/uploaded/web/National_Conversation/PSEL-LeadersCultureBundle-October2017NationalConversation.pdf CPSI (2017) Article Patient Safety & Quality Culture Bundle for CEOs & Senior Leaders
Board educated, engaged, accountable, prioritizes patient safety http://ihpme.utoronto.ca/wp-content/uploads/2015/11/Beyond-the-Quick-Fix-Baker-2015.pdf Institute of Health Policy, Management and Evaluation University of Toronto (2015) Report Beyond The Quick Fix: Strategies for Improving Patient Safety
Board educated, engaged, accountable, prioritizes patient safety http://www.patientsafetyinstitute.ca/en/About/
Documents/The%20Case%20for%20Investing
%20in%20Patient%20Safety.pdf#search=quality
%20and%20patient%20safety%20infrastructure
CPSI (2017) Report The case for investing in patient safety in Canada
Board educated, engaged, accountable, prioritizes patient safety http://www.patientsafetyinstitute.ca/en/About/
Programs/shift-to-safety/Pages/leader.aspx
CPSI webpage SHIFT to safety- Leader
Board educated, engaged, accountable, prioritizes patient safety http://high-reliability.org/High-Reliability-Organizations High-Reliability.org/.com webpage High Reliability Organizations
Board educated, engaged, accountable, prioritizes patient safety https://www.jcrinc.com/patient-safety-initiative-hospital-e
xecutive-and-physician-leadership-strategies/
Joint Commission Resources Guide Patient Safety Initiative: Hospital Executive and Physician Leadership strategies
Safety/quality vision, strategy, plan, goals http://www.ahaphysicianforum.org/resources/appropriate
-use/ACSC/content/AHRQ-PFE-Guide-selections.pdf
U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality Guide How patient and family engagement benefits your hospital
Safety/quality vision, strategy, plan, goals http://www.abqaurp.org/Docs/NCICLE_Patient-Safety-2017.pdf National Collaborative for Improving the Clinical Learning Environment (2017) Guide The role or clinical learning environments in preparing new clinicians to engage in patient safety
Safety/quality vision, strategy, plan, goals https://pdfs.semanticscholar.org/b9be/fbe21ea81cef6cff76
d28b9896a25c1d936d.pdf
Annu. Rev. Public Health (2013) Report Reducing Hospital Errors: Interventions that build safety
Safety/quality vision, strategy, plan, goals http://www.patientsafetyinstitute.ca/en/education/
TeamSTEPPS/Pages/default.aspx
CPSI Education Program TeamSTEPPS Canada™      TeamSTEPPS Canada™
Safety/quality vision, strategy, plan, goals http://www.patientsafetyinstitute.ca/en/education/psoc/
Pages/default.aspx
CPSI Education Program Canadian Patient Safety Officer Course
Safety/quality vision, strategy, plan, goals http://www.patientsafetyinstitute.ca/en/toolsResources/
Documents/Presentations/ALE%202017/ALE_Ginzburg_
PhysicianPartnership.pdf#search=quality%20and%20pat
ient%20safety%20infrastructure
CPSI Presentation Physician partnership: mission critical to advancing patient safety and quality
Safety/quality resources/infrastructure http://www.patientsafetyinstitute.ca/en/toolsResources/
Patient-Engagement-in-Patient-Safety-Guide/Pages/default.aspx
CPSI (2018) Guide Engaging patients in patient safety A Canadian Guide
Safety/quality resources/infrastructure http://www.patientsafetyinstitute.ca/en/toolsResources/
GovernancePatientSafety/RelationshipsBoardLeadershipStaff/
Documents/MD%20Engagement%20-%20Hayes.pdf#search
=quality%20and%20patient%20safet
y%20infrastructure
CPSI (2009) Presentation A Physician’s Perspective on Quality & Patient Safety
Safety/quality resources/infrastructure http://www.patientsafetyinstitute.ca/en/toolsResources/
Hospital-Harm-Measure/Improvement-Resources/pages/
general-patient-safety-quality-improvement-and-measurement-resources.aspx
CPSI Tools and Resources General Patient Safety Quality Improvement and Measurement Resources
Safety/quality resources/infrastructure https://www.jcrinc.com/the-joint-commission-journal-on-quality-and-patient-safety/ Joint Commission Resources Journal The Joint Commission Journal on Quality and Patient Safety

CEO/senior leadership behaviors


Component Link Resource Author Resource Type Resource Title
Relentless communication about safety/quality vision, stories, results http://www.memorialhermann.org/about-us/
quality-report-relentless-focus-on-quality-an-patient-safety/
Memorial Hermann webpage Quality report relentless focus on quality and patient safety
Relentless communication about safety/quality vision, stories, results http://www.patientsafetyinstitute.ca/en/
toolsResources/Member-Videos-and-Stories/Pages/default.aspx
CPSI Patient story Patient Stories
Relentless communication about safety/quality vision, stories, results https://patientsafetymovement.org/
advocacy/patients-and-families/patient-stories/
Patient Safety Movement Patient stories Patient Stories- Patient Safety Movement Foundation
Relentless communication about safety/quality vision, stories, results http://www.ihi.org/resources/pages/
ViewAll.aspx?FilterField1=IHI_x0020_Content_x0020_Type
&FilterValue1=b13a2504-4b3b-44e9-ae27-993451ffa7ae&Filter1ChainingOperator=And&FilterField3
=IHI_x0020_Offering&FilterValue3=864a4cda-a1e1-4685-a70b-dcffcd75433d&Filter3ChainingOperator=And&TargetWebPath
=/education/ihiopenschool/resources&orb=Title&ChangeDateOrder=true
IHI Patient stories Patient Stories, IHI Open School
Relentless communication about safety/quality vision, stories, results https://www.england.nhs.uk/6cs/wp-content
/uploads/sites/25/2015/09/scht-storytelling-toolkit.pdf
NHS (2015) Tools and Resources Using stories to improve Patient, Carer and Staff experiences and outcomes.  A resource to help you
Relentless communication about safety/quality vision, stories, results https://www.researchgate.net/publication/
6718306_We_listen_but_do_we_hear_The_importance_of_patient_stories
British Journal of Community Nursing (2006) Article We listen but do we hear? The importance of patient stories
Relentless communication about safety/quality vision, stories, results https://www.cfhi-fcass.ca/sf-docs/
default-source/on-call/on-call-november8-2016-patient-stories-e.pdf?sfvrsn=ca03d544_2
CFHI (2016) Presentation Using Patient Stories for Learning and Improvement
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families https://www.colleaga.org/sites/
default/files/leadership-rounds.pdf
Alberta Health Services Patient & Family Advisory Group Presentation Leadership rounding, connect with patients, families and staff for valuable insights
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families https://web.archive.org/web/20150520061309/
http:/www.myrounding.com/blog/5-questions-to-ask-when-leadership-rounding-on-front-lines
My Rounding (2015) Article 5 QUESTIONS TO ASK WHEN LEADERSHIP ROUNDING ON THE FRONT LINES
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families http://www.healthcarebusinesstech.com/
leadership-rounds-patient-safety/
Healthcare Business & Technology (2017) Article Leadership rounds: Create a ‘patient safety first’ culture
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families http://www.ihi.org/resources/Pages/
Tools/PatientSafetyLeadershipWalkRounds.aspx
IHI Website Patient Safety Leadership WalkRounds™
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families http://pxjournal.org/cgi/
viewcontent.cgi?article=1036&context=journal
Patient Experience Journal (2014) Article Improving the patient experience through nurse leader rounds
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families https://cjon.ons.org/cjon/18/6/
round-and-round-we-go-rounding-strategies-impact-exemplary-professional-practice
Clinical Journal of Oncology Nursing ( 2014) Article Round and Round We Go: Rounding Strategies to Impact Exemplary Professional Practice
Leadership Regular/daily interaction with care settings/units, staff, physicians, patients and families https://augusta.openrepository.com/
augusta/handle/10675.2/237
Medical College of Georgia (2010) Guide Navigating Patient- and Family-Centered Care Rounds: A guide to A guide to achieving Success
Model key values http://corevaluespartners.com/wp-content/
uploads/2013/10/Core-Values-and-Concepts-Health-Care.pdf
Core Value Partners (2013) Article Core Values and Concepts- Healthcare
Model key values https://catalyst.nejm.org/five-changes
-great-leaders-improvement-culture/
Catalysis (2017) Website PHYSICIANS LEADING | LEADING PHYSICIANS Five Changes Great Leaders Make to Develop an Improvement Culture

Human Resources

Component Link Resource Author Resource Type Resource Title
Leaders/staff/physicians engaged, clear expectations/incentives for safety/quality https://www.ncbi.nlm.nih.gov/
books/NBK43652/
Agency for Healthcare Research and Quality (2008) Book Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools).The Use of Modest Incentives to Boost Adoption of Safety Practices and Systems
Leaders/staff/physicians engaged, clear expectations/incentives for safety/quality https://www.cfhi-fcass.ca/sf-docs/default-source/
reports/Exploring-Dynamics-Physician-Engagement-Denis-E.pdf?sfvrsn=0
CFHI (2013) Report EXPLORING THE DYNAMICS OF PHYSICIAN ENGAGEMENT AND LEADERSHIP FOR HEALTH SYSTEM IMPROVEMENT
Leaders/staff/physicians engaged, clear expectations/incentives for safety/quality http://www.bailit-health.com/
articles/NHCPI-incentive-models.pdf
Bailit Health Purchasing, LLC (2002) Report Provider Incentive Models for Improving Quality of Care
Just culture program/protocol https://www.hptinstitute.com/wp-content/
uploads/2014/01/How-can-leaders-influence-a
-safety-culture-thought-paper-Michael-Leonard-Allan-Frankel.pdf
The Health Foundation (2012) Article How can leaders influence a safety culture?
Just culture program/protocol https://www.osha.gov/shpguidelines/docs/
Leading_a_Culture_of_Safety-A_Blueprint_for_Success.pdf
NPSF Lucian Leape Institute, The National Patient Safety Foundation at the Institute for Healthcare Improvement. The American College of Healthcare Executives Guide Leading a Culture of Safety: A Blueprint for Success
Just culture program/protocol http://www.royalcollege.ca/rcsite/
documents/health-policy/culture-of-patient-safety.pdf
Royal College of Physicians and Surgeons of Canada Guide Royal College of Physicians and Surgeons of Canada. Just Culture of Patient Safety
Just culture program/protocol https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3776518/
The Ochsner Journal (2013) Article Just Culture: A Foundation for Balanced Accountability and Patient Safety
Just culture program/protocol https://healthstandards.org/leading-practice/
building-a-just-culture-at-the-ottawa-hospital/
Health Standards Org (2017) Article Leading Practices Building a Just Culture at The Ottawa Hospital
Disruptive behaviour protocol https://www.cmpa-acpm.ca/en/advice-publications/
browse-articles/2013/addressing-physician-disruptive-behaviour-in-healthcare-institutions
CMPA webpage Addressing physician disruptive behaviour in healthcare institutions
Disruptive behaviour protocol https://www.cpso.on.ca/admin/CPSO/media/
Documents/physician/polices-and-guidance/policies/
guidebook-managing-disruptive-physician-behaviour.pdf
College of Physicians and Surgeons of Ontario (2008) Guide GUIDEBOOK FOR MANAGING DISRUPTIVE PHYSICIAN BEHAVIOUR
Disruptive behaviour protocol http://hqca.ca/health-care-provider-resources/
frameworks/managing-disruptive-behavior-in-the-
healthcare-workplace-provincial-framework/
Health Quality Council of Alberta (2013) Guide Managing Disruptive Behaviour in the Healthcare Workplace – Provincial Framework
Disruptive behaviour protocol http://patientsafety.pa.gov/ADVISORIES/
documents/2010sup2_04.pdf
Pennsylvania Patient Safety Advisory (2010) Article Chain of Command: When Disruptive Behavior Affects Communication and Teamwork
Disruptive behaviour protocol https://www.acog.org/Clinical-Guidance-and-Publications/
Committee-Opinions/Committee-on-Patient-Safety-and
-Quality-Improvement/Behavior-That-Undermines-a-Culture-of-Safety
American College of Obstetricians and Gynecologists (2017) Article Behavior That Undermines a Culture of Safety
Staff and physician safety (physical/psychological/burnout); safe environment program https://scholarworks.umass.edu/cgi/
viewcontent.cgi?article=1049&context=nursing_dnp_capstone
University of Massachusetts Amherst (2015) Guide The Just Culture, Second Victimization and Clinician Support: An Educational/Awareness Program
Staff and physician safety (physical/psychological/burnout); safe environment program https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC5041038/
Healthcare (2016) Article Burnout and Doctors: Prevalence, Prevention and Intervention
Staff and physician safety (physical/psychological/burnout); safe environment program https://www.cna-aiic.ca/~/media/cna/
page-content/pdf-en/fatigue_safety_2010_report_e.pdf
CNA (2010) Report Nurse Fatigue and Patient Safety
Staff and physician safety (physical/psychological/burnout); safe environment program https://journals.plos.org/plosone/
article?id=10.1371/journal.pone.0159015
PLOS (2016) Article Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review
Staff and physician safety (physical/psychological/burnout); safe environment program https://www.ncbi.nlm.nih.gov/
books/NBK2634/
Agency for Healthcare Research and Quality (2008) Book Patient Safety and Quality: An Evidence-Based Handbook for Nurses.  Chapter 21Creating a Safe and High-Quality Health Care Environment
Staff and physician safety (physical/psychological/burnout); safe environment program https://www.cma.ca/physician
-health-and-wellness
CMA webpage Canadian Medical Association Physician Health and Wellness
Staff and physician safety (physical/psychological/burnout); safe environment program http://www.acoem.org/uploadedFiles/Public_Affairs/
Policies_And_Position_Statements/Guidelines/Position
_Statements/Interaction_of_Health_Care_
Worker_Health_and.17.pdf
American College of Occupational and Environmental Medicine (2016) Article Interaction of Health Care Worker Health and Safety and Patient Health and Safety in the US Health Care System: Recommendations From the 2016 Summit

Health information/technology/devices


Component Link Resource Author Resource Type Resource Title
E-health records support safety http://www.patientsafetyinstitute.ca/en/education/
PatientSafetyEducationProgram/PatientSafetyEducationCurriculum/
Documents/Module%2006%20-%20Technology.pdf
CPSI Education Program PSEP. Module 6: Technology: Impact on Patient Safety
E-health records support safety https://www.cihi.ca/en/about-cihi/
corporate-strategies/how-is-cihi-data
-used-to-support-health-systems
CIHI webpage How Is CIHI Data Used to Support Health Systems?
Technology/devices support safety http://www.patientsafetyinstitute.ca/en/
newsalerts/alerts/pages/default.aspx
CPSI webpage Global Patient Safety Alerts
Technology/devices support safety https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC5840769/
BMC Med Ethics (2018) Article Leaving patients to their own devices? Smart technology, safety and therapeutic relationships
Technology/devices support safety https://qualitysafety.bmj.com/
content/19/Suppl_2/i3.info
BMJ Quality & Safety (2010) Article Technology as applied to patient safety: an overview
Technology/devices support safety https://www.ahrq.gov/downloads/
pub/advances2/vol1/Advances-Henriksen_104.pdf
AHRQ Article Envisioning Patient Safety in the Year 2025: Eight Perspectives
Technology/devices support safety http://www.sciedu.ca/journal/index
.php/jnep/article/view/4187/2652
Journal of Nursing Education and Practice (2014) Article Integration of health information technology to improve patient safety

Healthcare system alignment


Component Link Resource Author Resource Type Resource Title
Community/industry-wide collaborations https://www.jmirs.org/article/
S1939-8654(16)30117-5/fulltext
Journal of Medical Imaging and Radiation Sciences (2017) Article Collaboration in Health Care
Community/industry-wide collaborations https://docplayer.net/18393936-Interprofessional
-collaborative-practice-in-healthcare-getting
-prepared-preparing-to-succeed.html
Elsevier (2013) Article INTERPROFESSIONAL COLLABORATIVE PRACTICE IN HEALTHCARE Getting Prepared, Preparing to Succeed
Community/industry-wide collaborations https://www.nap.edu/read/21755/chapter/5 Institute of Medicine of the National Academies (2016) Book Collaboration  Between Health Care and Public Health: Workshop Summary (2016) Chapter: 4 Collaboration Between Hospitals and Public Health Agencies
Community/industry-wide collaborations https://www.cfhi-fcass.ca/Libraries/
Commissioned_Research_Reports/Virani
-Interprofessional-EN.sflb.ashx
Canadian Health Services Research Foundation (2012) Article Interprofessional Collaborative Teams
Align with national/international standards http://www.patientsafetyinstitute.ca/en/
About/PatientSafetyForwardWith4/Pages/
Integrated-Patient-Safety-Action-Plan.aspx
CPSI webpage Integrated Patient Safety Action Plan
Align with national/international standards https://www.prescribeit.ca/about-us/
the-prescribeit-advantage?gclid=CjwKC
Ajw8ajcBRBSEiwAsSky_b
fN9uMvJUMtnIMTgLGi9XP5StldNDgvQ
KEfNCIcxytsqTRpwOVovxoCtjEQAvD_BwE
PrescribeIT™ webpage PrescribeIT
Align with national/international standards https://www.ismp-canada.org/download/MedRec/
20121101MedRecCanadaENG.pdf
ISMP (2012) Article Medication Reconciliation in Canada: Raising The Bar – Progress to date and the course ahead.
Align with national/international standards https://www.ncbi.nlm.nih.gov/
pubmed/27009711
Health c Q (2016) Article Patient Safety Incident Reporting: Current Trends and Gaps Within the Canadian Health System
Align with national/international standards https://www.ornac.ca/en/about-us ORNAC webpage ORNAC About us