In this resource :

  • Patient Safety Culture Bundle

Enacting 

Frontline actions that improve patient 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 ENACTING components of the Bundle. 

The table below addresses frontline actions that improve patient safety. The ENACTING section provides tools and resources to help leadership appropriately support care settings and managers’ care processes; support patient and family engagement/co-production of care; and ensure organizational situational awareness/resilience. 

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

Care settings and managers


Component Link Resource Author Resource Type Resource Title
Integrated, unit/setting-based safety practices https://www.jointcommissionjournal.com/article/S1553-7250(16)30020-4/abstract The Joint Commission (2017) Article Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice
Integrated, unit/setting-based safety practices https://www.albertahealthservices.ca/publications/ahs-pub-hc-quarterly.pdf Healthcare Quartely (2009) Article Integrated Care- Alberta Health Services
Integrated, unit/setting-based safety practices https://www.isc.hbs.edu/health-care/vbhcd/Pages/integrated-practice-units.aspx Harvard Business School Website Integrated Practice Units<br>ORGANIZING CARE AROUND PATIENT MEDICAL CONDITIONS
Integrated, unit/setting-based safety practices http://app.ihi.org/FacultyDocuments/Events/Event-2354/Presentation-8854/Document-7492/C5_Presentation.pdf IHI (2013) Article Huddles Developing Situational Awareness
Integrated, unit/setting-based safety practices https://www.saskatoonhealthregion.ca/about/PFMS/Pages/Daily-Visual-Management.aspx Saskatoon Health Authority Education Program Patient First Management System. Daily Visual Management
Integrated, unit/setting-based safety practices https://www.tandfonline.com/doi/abs/10.1080/09537287.2017.1358830?src=recsys&journalCode=tppc20 Production Planning & Control (2017) Article Visual management system to improve care planning and controlling: the case of intensive care unit
Integrated, unit/setting-based safety practices https://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_opt_briefings-facnotes.html Agency for Healthcare Research and Quality Presentation Optimize Briefings and Debriefings: Facilitator Notes

Care settings and managers


Managers/physician leaders foster psychological safety https://www.psqh.com/analysis/are-second-victims-getting-the-help-they-need/ Parient Safety and Quality Healthcare (2018) Article Are Second Victims Getting the Help They Need?
Managers/physician leaders foster psychological safety https://www.doctorsofbc.ca/sites/default/files/2017-06-promotingpsychologicalsafetyforphysicians_id_113100.pdf Doctors of BC (2017) Article Promoting Psychological Safety for Physicians
Managers/physician leaders foster psychological safety https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2018/how-physician-leaders-can-nurture-teams-that-provide-highly-reliable-healthcare Canadian Medical Protective Association (2018) Article How physician leaders can nurture teams that provide highly reliable healthcare
Managers/physician leaders foster psychological safety https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5180524/ Journal of Graduate Medical Education (2016) Article Does Psychological Safety Impact the Clinical Learning Environment for Resident Physicians? Results From the VA's Learners' Perceptions Survey
Managers/physician leaders foster psychological safety https://qualitysafety.bmj.com/content/13/suppl_2/ii3 Quality and Safety in Health Care (2004) Article Learning from failure in health care: frequent opportunities, pervasive barriers
Managers/physician leaders foster psychological safety http://www.royalcollege.ca/rcsite/documents/health-policy/culture-of-patient-safety.pdf Royal College of Physicians and Surgeons of Canada Guide A culture of patient safety: Foundation for a Royal College patient safety roadmap

Care processes


Component Link Resource Author Resource Type Resource Title
Standardized work/care processes where appropriate https://www.patientsafetyinstitute.ca/en/toolsresources/pages/surgicalsafety-checklist-resources.aspx CPSI Webpage Surgical Safety Checklist: Download
Standardized work/care processes where appropriate https://www.virginiamasoninstitute.org/2015/05/how-does-standard-work-lead-to-better-patient-safety/ Virginia Mason Institute (2015) Article How Does Standard Work Lead to Better Patient Safety?
Standardized work/care processes where appropriate https://academic.oup.com/intqhc/article/26/2/109/1803803 International Journal for Quality in Health Care (2014) Article Standardization in patient safety: the WHO High 5s project
Standardized work/care processes where appropriate https://link.springer.com/article/10.1007/s40746-015-0026-4#citeas Current Treatment Options in Pediatrics (2015) Article Standardizing Care Processes and Improving Quality Using Pathways and Continuous Quality Improvement
Standardized work/care processes where appropriate https://www.youtube.com/watch?v=EBaQDrbw7hM Center for Health Care Value Video 3 types of Standard Work in Healthcare
Communication/patient hand-off protocols http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf WHO Collaborating Centre for Patient Safety Solutions (2007) Article Communication During Patient Hand-Overs
Communication/patient hand-off protocols https://www.ncbi.nlm.nih.gov/books/NBK2649/ Patient Safety and Quality (2008) Book Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 34 Handoffs: Implications for Nurses
Communication/patient hand-off protocols http://www.scielo.br/pdf/ean/v22n2/1414-8145-ean-2177-9465-EAN-2017-0268.pdf EEAN (2017) Article Handoff communication in intensive care: links with patient safety
Communication/patient hand-off protocols https://deepblue.lib.umich.edu/bitstream/handle/2027.42/63698/yford_1.pdf?sequence=1 Yvonne Barthel Ford (2009) Article Talking About Patients: Nurses Language Use During Hand-offs
Communication/patient hand-off protocols https://scholarworks.uark.edu/cgi/viewcontent.cgi?referer=https://www.google.ca/&httpsredir=1&article=1029&context=nursuht University of Arkansas (2014) Report A Qualitative Study Evaluating Bedside Reporting and the Impact on Nurse Satisfaction and Communication Barriers with Washington Regional Medical Center

Patient and family engagement/co-production of care


Patients/families partners in all aspects of care http://www.patientsafetyinstitute.ca/en/toolsResources/Patient-Engagement-in-Patient-Safety-Guide/Documents/Partners%20at%20organizational%20and%20system%20levels.pdf CPSI Guide Engaging Patients in Patient Safety. A Canadian Guide
Patients/families partners in all aspects of care http://www.ipfcc.org/resources/PartneringwithPatientsandFamilies.pdf Institute for Family Centered Care (2011) Article Partnering with Patients and Families to Design a Patientand Family-Centered Health Care System
Patients/families partners in all aspects of care http://pediatrics.aappublications.org/content/pediatrics/early/2014/12/23/peds.2014-3424.full.pdf American Academy of Pediatrics (2015) Report Patient- and Family-Centered Care of Children in the Emergency Department
Patients/families partners in all aspects of care https://www.cfhi-fcass.ca/sf-docs/default-source/patient-engagement/better-together-change-package.pdf?sfvrsn=9656d044_4 CFHI (2015) Guide Better Together: A Change Package to Support the Adoption of Family Presence and Participation in Acute Care Hospitals and Accelerate Healthcare Improvement
Patients/families involved in local safety/quality initiatives http://www.patientsafetyinstitute.ca/en/About/Programs/PPSC/Pages/default.aspx CPSI Webpage Patients for Patient Safety Canada
Patients/families involved in local safety/quality initiatives https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/PatientSafety/ CAPHC Webpage CAPHC Patient Safety Collaborative
Patients/families involved in local safety/quality initiatives https://www.canada.ca/en/health-canada/services/quality-care/patient-safety/current-patient-safety-organizations-canada.html Governamnet of Canada Webpage Current patient safety organizations in Canada
Patients/families involved in local safety/quality initiatives http://www.patientsafetyinstitute.ca/en/About/Programs/shift-to-safety/Pages/public.aspx CPSI Webpage SHIFT to Safety - Public
Patients/families involved in local safety/quality initiatives http://www.ipfcc.org/resources/Patient-Safety-Toolkit-04.pdf Institute for Patient and Family Centered Care Tools and Resources Partnering with Patients and Families to Enhance Safety and Quality<br>A Mini Toolkit
Disclosure and apology protocols https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536280/ PLoS One (2017) Article Apology in cases of medical error disclosure: Thoughts based on a preliminary study
Disclosure and apology protocols https://www.healthaffairs.org/action/showCitFormats?doi=10.1377%2Fhlthaff.2013.0831 Health Affairs (2014) Article Structuring Patient And Family Involvement In Medical Error Event Disclosure And Analysis
Disclosure and apology protocols http://healthydebate.ca/2013/12/topic/quality/disclosing-medical-errors Healthy Debate (2013) Article Medical error disclosure: improving patient safety through better communication

Situational awareness/resilience


Processes for real-time/early detection of safety risks and patient deterioration http://www.patientsafetyinstitute.ca/en/About/Programs/shift-to-safety/Pages/provider.aspx CPSI Webpage SHIFT to Safety - Provider
Processes for real-time/early detection of safety risks and patient deterioration https://qualitysafety.bmj.com/content/early/2018/06/29/bmjqs-2017-007525 BMJ Qual Saf (2018) Article Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers
Protocols for escalation of care concerns https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600219/ Health Expectations (2017) Article Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review
Protocols for escalation of care concerns https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2017/how-to-manage-conflict-and-aggressive-behaviour-in-medical-practice CMPA (2017) Article How to manage conflict and aggressive behaviour in medical practice
Protocols for escalation of care concerns https://www.mayoclinicproceedings.org/article/S0025-6196(17)30394-4/pdf Mayo Foundation for Medical Education and Reseach (2017) Article When Patients and Their Families Feel Like Hostages to Health Care
Protocols for escalation of care concerns https://www.rch.org.au/uploadedFiles/Main/Content/medicaleducation/RCH%20Escalation%20chart.pdf Royal Children's Melbourne Hospital Tools and Resources Patient and family escalation process
Protocols for escalation of care concerns https://www.albertahealthservices.ca/about/patientfeedback.aspx Alberta Health Services Webpage Patient Concerns & Feedback