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 | Resource Author | Resource Type | Resource Title |
| Integrated, unit/setting-based safety practices | 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 | Healthcare Quartely (2009) | Article | Integrated Care- Alberta Health Services |
| Integrated, unit/setting-based safety practices | Harvard Business School | Website | Integrated Practice Units ORGANIZING CARE AROUND PATIENT MEDICAL CONDITIONS |
| Integrated, unit/setting-based safety practices | IHI (2013) | Article | Huddles Developing Situational Awareness |
| Integrated, unit/setting-based safety practices | Saskatoon Health Authority | Education Program | Patient First Management System. Daily Visual Management |
| Integrated, unit/setting-based safety practices | 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 | Agency for Healthcare Research and Quality | Presentation | Optimize Briefings and Debriefings: Facilitator Notes |
Care settings and managers
| Component | Resource Author | Resource Type | Resource Title |
| Managers/physician leaders foster psychological safety | Parient Safety and Quality Healthcare (2018) | Article | Are Second Victims Getting the Help They Need? |
| Managers/physician leaders foster psychological safety | Doctors of BC (2017) | Article | Promoting Psychological Safety for Physicians |
| Managers/physician leaders foster psychological safety | Canadian Medical Protective Association (2018) | Article | How physician leaders can nurture teams that provide highly reliable healthcare |
| Managers/physician leaders foster psychological safety | 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 | Quality and Safety in Health Care (2004) | Article | Learning from failure in health care: frequent opportunities, pervasive barriers |
| Managers/physician leaders foster psychological safety | 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 | Resource Author | Resource Type | Resource Title |
| Standardized work/care processes where appropriate | CPSI | Webpage | Surgical Safety Checklist: Download |
| Standardized work/care processes where appropriate | Virginia Mason Institute (2015) | Article | How Does Standard Work Lead to Better Patient Safety? |
| Standardized work/care processes where appropriate | International Journal for Quality in Health Care (2014) | Article | Standardization in patient safety: the WHO High 5s project |
| Standardized work/care processes where appropriate | 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 | Center for Health Care Value | Video | 3 types of Standard Work in Healthcare |
| Communication/patient hand-off protocols | WHO Collaborating Centre for Patient Safety Solutions (2007) | Article | Communication During Patient Hand-Overs |
| Communication/patient hand-off protocols | 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 | EEAN (2017) | Article | Handoff communication in intensive care: links with patient safety |
| Communication/patient hand-off protocols | Yvonne Barthel Ford (2009) | Article | Talking About Patients: Nurses Language Use During Hand-offs |
| Communication/patient hand-off protocols | 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
| Component | Resource Author | Resource Type | Resource Title |
| Patients/families partners in all aspects of care | CPSI | Guide | Engaging Patients in Patient Safety. A Canadian Guide |
| Patients/families partners in all aspects of care | 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 | American Academy of Pediatrics (2015) | Report | Patient- and Family-Centered Care of Children in the Emergency Department |
| Patients/families involved in local safety/quality initiatives | CPSI | Webpage | Patients for Patient Safety Canada |
| Patients/families involved in local safety/quality initiatives | CAPHC | Webpage | CAPHC Patient Safety Collaborative |
| Patients/families involved in local safety/quality initiatives | Governamnet of Canada | Webpage | Current patient safety organizations in Canada |
| Patients/families involved in local safety/quality initiatives | Institute for Patient and Family Centered Care | Tools and Resources | Partnering with Patients and Families to Enhance Safety and Quality A Mini Toolkit |
| Disclosure and apology protocols | PLoS One (2017) | Article | Apology in cases of medical error disclosure: Thoughts based on a preliminary study |
| Disclosure and apology protocols | Health Affairs (2014) | Article | Structuring Patient And Family Involvement In Medical Error Event Disclosure And Analysis |
| Disclosure and apology protocols | Healthy Debate (2013) | Article | Medical error disclosure: improving patient safety through better communication |
Situational awareness/resilience
| Component | Resource Author | Resource Type | Resource Title |
| Processes for real-time/early detection of safety risks and patient deterioration | 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 | 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 | CMPA (2017) | Article | How to manage conflict and aggressive behaviour in medical practice |
| Protocols for escalation of care concerns | 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 | Royal Children's Melbourne Hospital | Tools and Resources | Patient and family escalation process |
| Protocols for escalation of care concerns | Alberta Health Services | Webpage | Patient Concerns & Feedback |
