Presence of Safety

Transforming from the absence of harm to the presence of safety

Healthcare Excellence Canada plays an important role in shaping the way patient safety is defined and understood. Initially through the work of the Canadian Patient Safety Institute (CPSI)* and now as HEC, we are supporting a transformative shift from seeing safety as the absence of harm to a more holistic approach to fostering safe, inclusive care. One of the primary ways we are doing this is by working to apply the leading framework for measuring and monitoring safety, to see what lessons can be learned about its application in Canada. 

A framework for expanding the definition of safety 

The release of the Measurement and Monitoring Safety Framework (MMSF) in 2013 catalyzed a major change in the way safety is defined and practiced. Created by Professor Charles Vincent and colleagues at The Health Foundation, the MMSF presented an approach for shifting away from focusing on the absence of harm towards adopting a broader view of safety. This new view examined the sources of resilience and capabilities that enable safe care and endorsed a less reactive approach to improving safety (presence of safety).  

Applying the framework in Canada 

In 2017, the Canadian Patient Safety Institute (CPSI)* began working with healthcare teams from across the country to advance our knowledge and experience of the MMSF in Canada. Following a successful demonstration project led by Dr. Ross Baker at the University of Toronto, a subsequent learning collaborative was launched in 2018 with 11 teams from seven provinces. Each team used the MMSF to develop a more comprehensive approach to delivering safer care.   

An evaluation in 2020 concluded that the collaborative successfully built the capacity of teams to understand and implement the MMSF in their local settings. Participants reported positive impacts on stakeholder groups' knowledge and behaviours, healthcare processes, and patient outcomes.

Measuring and monitoring safety: A patient and care partner perspective  

The evaluation showed that the MMSF improved safety practices and was well-received by frontline teams, senior leaders and board members. Limited attention, however, had been paid to how patients engage with this wider view of safety. 

The release of How Safe is Your Care? Measurement and monitoring of safety through the eyes of patients and their care partners provides important insights into how patients and their care partners see safety. The report offers guidance on how to effectively engage patients and care partners in all aspects of measurement and monitoring of safety and provides recommendations outlining how to strengthen provider and patient partnerships in support of safer care.

A timeline of the presence of safety  

Important work has taken place to evolve our understanding of patient safety, what it means to different stakeholders, and how to foster it. While there has been tremendous progress, more work is needed to refine this understanding and address harm. As early adopters and leaders on the MMSF in Canada, Healthcare Excellence Canada and partners have a role to play in this effort—one that we hope you will join—so that we can truly transform to the presence of safety. Together. 

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Timeline: Patient safety in Canada

2002: Building a Safer System: A National Integrated Strategy for Improving Patient Safety in Canadian Health Care report recommends creating the Canadian Patient Safety Institute (CPSI).* 

2003: CPSI created, with funding and support from Health Canada. 

2003: The Canadian Patient Safety Dictionary defines patient safety as “The pursuit of the reduction and mitigation of unsafe acts within the health care system, as well as the use of best practices shown to lead to optimal patient outcomes.” 

2004: The launch of CPSI followed by the release of the Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada study is 2004, initiated Canadian efforts to identify the incidence of unintended harm resulting from care, and to implement strategies that reduced such harm. 

2005:  Safer Healthcare Now! launched in Canada as the first pan-Canadian quality improvement campaign.  

2006:  Patients for Patient Safety Canada created. 

2013: Measurement and Monitoring Safety Framework (MMSF) created by Professor Charles Vincent and colleagues from the Health Foundation. This new approach assesses and evaluates safety from "ward to board" by providing a comprehensive and accurate real-time view of patient safety. The Framework helps users move from "assurance" to "inquiry" by shifting away from a focus on past cases of harm towards current performance, future risks and organizational resiliency. 

2017: CPSI begins working with healthcare teams from across Canada to advance our knowledge and experience of the Measurement and Monitoring of Safety Framework in Canada by launching a 12-month demonstration project lead by CPSI and in collaboration with Dr. Ross Baker at the University of Toronto. During this collaborative, participating teams were supported in rewiring their thinking on patient safety and worked within their organization to foster and promote a new approach to safety. 

2018: CPSI launches an 18-month learning collaborative to enable the implementation of the MMSF amongst 11 teams from seven provinces in Canada.  

2019: The research study, How Safe is Your Care? Measurement and monitoring of safety through the eyes of patients and their care partners, launched to understand patients’ and care partners’ views of the MMSF and the translation of these ideas into potential avenues for action that can reinforce and extend current patient and care partners’ engagement with safety. 

2020: Evaluation of the Research of Measurement and Monitoring of Safety Framework Collaborative completed. 

2021: A new organization, Healthcare Excellence Canada (HEC) brings together the Canadian Patient Safety Institute and Canadian Foundation for Healthcare Improvement. The newly amalgamated organization works with partners to share proven innovations and best practices in patient safety and healthcare quality. 

HEC launches innovative consultation process to redefine patient safety. The new definition aims to provide a more holistic definition that moves from a focus on the absence of harm to the presence of safety. 

2022: Publication of How Safe is Your Care? Measurement and monitoring of safety through the eyes of patients and their care partners. 

* In 2021, the Canadian Patient Safety Institute (CPSI) and Canadian Foundation for Healthcare Improvement (CFHI) came together to form a new organization, Healthcare Excellence Canada (HEC).

Key resources

• Measurement and Monitoring of Safety in Canada Learning Collaborative 
• Evaluation Research of Measurement and Monitoring of Safety Framework Collaborative 
• Testimonials 
• Learn more about MMSF in Canada 
• "How Safe is Your Care?" Measurement and Monitoring of Safety Through the Eyes of Patients and their Caregivers - Research Project 
• Other Resources 

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