The evolving patient safety landscape in Canada: refine or rethink?

Voices Shaping Safer Care is a blog series featuring reflections and experiences from people across health and social care in Canada. Through stories from patients, caregivers, healthcare providers, leaders and community partners, the series explores the everyday moments, relationships and systems that influence safety.

When it comes to acute care settings that practice patient safety well, Ross Baker notes that some hospitals have made substantial improvements in safety. “These hospitals have a detailed strategy to address safety issues and they review the impact of their programs carefully to ensure their impact,” says Baker. “Most importantly, these organizations have strong safety leadership from the board and senior executive to the point of care and they have developed a strong safety culture that encourages staff, patients and families to speak up for safety.”

The evidence that helped shape safer care

Baker co-led the 2004 Canadian Adverse Events Study with Dr. Peter Norton which analyzed patient records in 20 Canadian hospitals across the country. The study found that one in 13 patients (7.5 percent) were unintentionally injured during their stay.

These findings helped bring greater attention to patient safety across the health sector. They prompted changes in policy, leadership, accreditation and organizational culture, alongside a growing role for patients in making care safer.

Today, more than two decades later, patient safety is no longer a hidden issue – and has expanded to include not only physical harm but also other forms of harm including psychological, social, spiritual and cultural harm.

While Baker’s work helped bring patient safety to the forefront, today he’s less interested in its catalyzing role and more focused on what the current data are telling us: “A study that’s more than 20 years old is a useful marker of the history, but it doesn’t tell us where we need to focus today,” says Baker.

And what he sees has him concerned.

The latest data: opportunity or red flag?

Baker points to a recent Canadian study led by Dr. Guosong Wu at the University of Calgary which shows a rate of adverse events significantly higher than the original 2004 research. The 2026 study, analyzed over 10,000 patient admissions in Calgary, Alberta and found 2,310 adverse events – a rate of 21.6 percent. This rate is dramatically higher than the rates of earlier studies and the current data found in CIHI’s Hospital Harm data, which reported harm in 1 in 17 hospital stays.

Baker emphasizes the value of the evidence from the new Calgary study and a similar study of Massachusetts hospitals. The Massachusetts study found that 23.6% of acute care patients experienced preventable harm. Both studies point to the need to review and strengthen patient safety efforts. 

“My biggest concern now is that we're not reducing the level of events,” he explains. “We have some clear evidence that in some settings, there's a much higher incidence. We need to review our current strategies within and across hospitals (as well as other care sites) to reduce patient harm.”

And of course, there’s the question of why this is the case. Baker believes there are several reasons, including:

• The growing adoption of electronic medical records, which offer more easily accessible information than the paper charts on which earlier research was based; and

• The changes in healthcare staffing since 2002. Hospitals have lost more experienced staff, especially because of the COVID-19 pandemic. Studies show, for example, that a reduction in nursing staff correlates to an increase in patient harm.

A call to action: what matters most now

What’s most important now, says Baker, is for hospitals to understand whether their current patient safety efforts are truly reducing harm. He mentions a study of hospital harm led by Dr. Chris Parshuram that is currently underway with this exact focus.

If patient safety programs aren’t reducing patient harm, then “we’re adding to the burden of staff without reducing the harm that happens to patients,” he says. “This would be a clear call to re-evaluate our initiatives, and how to do this safety work more effectively going forward.”

Baker also emphasizes the importance of patient safety in other care settings, especially as people age and require more home-based services. He sees lots of opportunity and points to Healthcare Excellence Canada’s leadership in bringing people together to make home and community care safer, using evidence to guide improvements.

“In healthcare environments, patient safety has to be a team sport,” he says. “It’s people – staff, patients, families and care partners – working together to create a safer care environment… And we have some good examples now of hospitals and other organizations that have been successful at this.”

Creating Safer Care

So, what does it take to create safer care? In a 2015 report, Baker outlines a few recommendations to improve care, including:

• Developing a patient safety and quality improvement plan that incorporates everything from leadership to specific patient safety events. Tools like HEC’s Safety Competencies Framework enables competencies that can be adopted and adapted by diverse healthcare programs to design courses to teach safety and quality. E-learning courses like the Foundations of Healthcare Excellence help teams understand the connections between safety, equity, engagement and cultural safety.

• Better measurement for improving safety beyond the measures of harm. The Measurement and Monitoring of Safety Framework offers a broader view of safety that is inclusive of past harm and helps us consider more proactive elements to ensure that care will be safe today and into the future. HEC’s Rethinking Patient Safety Discussion guide is a great way to start discussions to reframe patient safety.  

• Teamwork and leadership capacity need to have proper investment as they are more likely to create receptive environments for patient safety practices. HEC’s Framework for Establishing a Patient Safety Culture helps leaders establish a safety-focused culture. The TeamSTEPPS Canada Essentials course and the Effective Governance for Quality and Patient Safety course are great starting points to build capacity.

• Involving patients and caregivers in patient safety and quality improvement can offer new insights on existing practices and ways to improve. The Engaging Patients in Patient Safety guide to learn more, as well as Engagement Capable Environments e-learning series, to consider how to create the conditions for engagement.

There is lots of work to be done, as the reports and research tell us. But there are things we can do in our day-to-day practices and at the system-level to make care safer for everyone in Canada.