34 Healthcare Management Forum Gestion des soins de santé

Introductionational and international literature, research, and experience have ledto the identification of patient/client safety as a healthcare issuerequiring immediate attention. In 2002, the Canadian governmentbudgeted $50 million over five years for the creation of the CanadianPatient Safety Institute. The May 2004 publication of the CanadianAdverse Events Study (co-sponsored by the Canadian Institute forHealth Information and the Canadian Institutes of Health Research)reported that after adjustment for sampling strategy, the adverse

event rate was 7.5 per 100 hospital admissions in Canada.1 In June 2004, theCanadian Institute for Health Information (CIHI) released its fifth annualpublication on the state of healthcare in Canada. Health Care in Canada 2004noted that nearly a quarter of Canadian adults (5.2 million people) report thatthey or a member of their family have experienced a preventable adverseevent.2

Recent Canadian reports have suggested that the Canadian Council onHealth Services Accreditation (CCHSA) has a responsibility in an integratedapproach to improving patient/client safety. This was endorsed at a 2003Multi-Stakeholder Workshop on Quality hosted by CCHSA. It was clearlyexpressed that patient safety be dealt with at “arms’ length” from government,and that CCHSA, as an independent body, should play a stronger rolethrough its accreditation program.

2003 Accreditation Survey ResultsIn 2003, 13% of the total CCHSA accreditation recommendations werepatient/client safety-related and 65% of accreditation surveys generated atleast one patient safety-related recommendation. Most of these recommen-dations related to disaster and emergency planning; risk management;infection control; informed consent; use of equipment; medication use;timeliness; documentation; diagnostic testing; reporting incidents andadverse events; and design/layout of physical space.

CCHSA Patient Safety Goals CCHSA has always been focused on patient safety. At its core, accreditationis a risk reduction activity. Following a lengthy process that included literaturereviews, expert consultation, and multiple meetings with CCHSA’s PatientSafety Advisory Committee, six Patient Safety Goals and a number of relatedRequired Organizational Practices (ROPs) have been prioritized for 2005. Allaccredited organizations must comply with these goals and practices. It isexpected that the Patient Safety Goals and ROPs will evolve over time, asCanadian health service organizations move forward in addressing the patient/client safety challenges currently faced by the system. The Patient SafetyGoals are as follows:

N

Leadership’s Role in Patient/ClientSafety: Are we doing Enough?An Accreditation Perspective by Tracy Murphy and Paula Greco

Tracy Murphy, CHE, is a Consultant with theResearch and ProductDevelopment Team atthe Canadian Councilon Health ServicesAccreditation. Tracy iscurrently involved inCCHSA’s patient safetyand worklife portfolios.Tracy holds a Master’sDegree in Health

Administration, and is a Certified Health Executivethrough the Canadian College of Health ServiceExecutives. She is also an Educational Consultant forthe Modern Management Program of the CanadianHealthcare Association.

Paula Greco is theDirector, Research andProduct Developmentat the CanadianCouncil on HealthServices Accreditation.Paula has been atCCHSA for nearly 10 years, and leads a team of staff whoare responsible forconceptualizing,

developing, and pilot testing CCHSA’s new productsand services. Paula holds a Bachelor’s Degree inScience, a Bachelor’s Degree in Administration, and a Master’s Degree in Health Administration.

AbstractNational and international literature, research,and experience have led to the identificationof patient/client safety as a healthcare issuerequiring immediate attention. RecentCanadian reports have suggested that theCanadian Council on Health ServicesAccreditation (CCHSA) has a responsibility inan integrated approach to improvingpatient/client safety.

BRIEF REPORT

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1. Create a culture of safety within theorganization. One of the five associatedROPs is to adopt patient safety as awritten, strategic priority/goal.

2. Improve the effectiveness andcoordination of communicationamong care/service providers andwith the recipients of care/serviceacross the continuum. One of thefive associated ROPs is to inform andeducate patients/clients and/orfamily about their role in patientsafety, using both written and verbalcommunication.

3. Ensure the safe use of high-riskmedications. One of the twoassociated ROPs is to standardizeand limit the number of drugconcentrations available in theorganization.

4. Ensure the safe administration ofparenteral medications. The associatedROP is to provide ongoing, effectivetraining for service providers andusers on all infusion pumps.

5. Create a worklife and physicalenvironment that supports the safedelivery of care/service. One of thefour associated ROPs is to deliver atleast annual education/training onpatient safety to all staff, includingtargeted patient safety focus areaswithin the organization.

6. Reduce the risk of health serviceorganization-acquired infections andtheir impact across the continuum ofcare/service. One of the four associatedROPs is to adhere to federal and/orprovincially-developed infectioncontrol guidelines such as HealthCanada’s Infection Control Guidelines:Hand Washing, Cleaning, Disinfectionand Sterilization in Healthcare.

A full listing of CCHSA’s Patient SafetyGoals and all Required OrganizationalPractices can be found on its web site atwww.cchsa.ca.

The Linkage with Organizational Worklife As we contemplate patient/client safetyissues and take appropriate action, thelinkages between organizational worklifeand patient safety must be increasinglyrecognized. A recent review of theliterature sponsored by the U.S. Instituteof Medicine found that “there was

sufficient evidence to conclude thatseveral different specific workingconditions affect outcomes that arerelated to patient safety. There was alsosufficient evidence to conclude thatsome working conditions affect rates ofmedical errors.”3 For example, studieshave documented a relationship betweensome quality of care measures (e.g.urinary tract infections and pneumoniarates) and nursing staff levels and/or mix.Research has also linked care providers’emotional exhaustion, job satisfaction,and fatigue to measures of quality of carein some, but not all cases.

In another study, administrative data for799 hospitals in 11 U.S. states wasreviewed by researchers to examine therelationship between the amount of careprovided by nurses in hospital, andpatient outcomes. Researchers concludedthat a higher proportion of hours ofnursing care provided by registerednurses and a greater number of hours ofcare by registered nurses per day areassociated with better care forhospitalized patients.4

In 2002, the Academy of CanadianExecutive Nurses conducted a nationalsurvey on nurses’ perceptions of patientsafety. Nurses identified workload/paceof work, human resources, nursingshortage/staffing, restructuring/bedclosures, patient/clients, systems issues,physical environment, and technology/specialization as key themes that contributeto increased risk in patient care.5

Implications for LeadershipHealth service executives and managersmust play an active role in improvingpatient/client safety within their organiza-tions. Strong, involved leadership is asnecessary for patient/client safety improve-ment as it is for any other strategicinitiative. Moreover, the cultural changethat is required to enhance patient safetymust be driven and supported byleaders. Accordingly, key actions forconsideration by leaders include:

• thinking strategically about quality of patient/client safety within yourorganization;

• involving Board members in leadingyour patient/client safety initiatives,and in the integration of risk manage-ment into the strategic process;6

• taking action to address patient/clientsafety throughout the organization;

• preparing to meet CCHSA PatientSafety Goals and RequiredOrganizational Practices;

• strengthening knowledge base at alllevels of the organization;

• including the patient/client role insafety;

• acknowledging that all employees,care providers, and volunteers play arole in patient safety;

• ensuring that patient/client safetyimprovement initiatives are well-coordinated and regularly evaluated;and

• recognizing the link betweenorganizational worklife andpatient/client safety.

ConclusionHealth service organizations across thecountry, individually and collectively,need to work to improve patient/clientsafety. CCHSA is proud to take an activerole in helping to improve patient safetythrough the accreditation program.CCHSA’s new Patient Safety Goals andROPs should act as a catalyst toencourage patient safety improvementsand organizational cultural change.

CCHSA invites healthcare leaders tocontinue their involvement in improvingpatient/client safety. Senior leadershipcommitment, focused efforts, andregular evaluation will help to enhancethe safety of our health service system.We will all benefit from these efforts, andall Canadians deserve it.

References: 1. Baker R, Norton P, Flintoft V, Blais R, Brown A, Cox J, et al.

The Canadian adverse events study: the incidence of adverseevents among hospital patients in Canada. CanadianMedical Association Journal 2004;170(11):1678-1686.

2. Canadian Institute for Health Information. Health Care inCanada (2004).

3. Agency for Healthcare Research and Quality. The Effect ofHealth Care Working Conditions on Patient Safety (2003).Web site address: www.ahrq.gov/clinic/epcsums/worksum.htm

4. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K.Nurse-staffing levels and the quality of care in hospitals.New England Journal of Medicine 2002;346(22):1715-1722.

5. Nicklin W, McVeety JE. Canadian nurses’ perceptions ofpatient safety in hospitals. Canadian Journal of NursingLeadership 2002;15(3):11-21.

6. Patrick L. Building an effective risk management program ina healthcare setting. Healthcare Management Forum2004;17(3):27-29.

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