Policy, Legal and Regulatory Affairs Advisory Committee
The Policy, Legal and Regulatory Affairs Advisory Committee is comprised of leaders and experts from medicine, nursing, regulatory bodies, education, law, governments and non-government organizations, and patient partners. The Advisory Committee is mandated to provide strategic advice that enables the Canadian Patient Safety Institute to be a catalyst that influences patient safety issues and directions as they relate to federal, provincial and territorial health priorities and policy, health law and legislation, and regulatory systems and standards.
Two full-day in-person meetings and two teleconferences were held, where the Advisory Committee provided strategic advice and guidance related to various policy issues, such as the variability in patient safety legislation, specifically as it relates to mandatory reporting.
Under the guidance of the Advisory Committee, a Canadian Patient Safety Institute Policy Framework was developed this year – it lays the foundation and the roadmap for the Canadian Patient Safety Institute’s approach to informing and influencing policy across Canada through five key levers: legislation, regulation, standards, organizational policies, and public engagement. The Policy Framework will be released by the end of 2019.
Several key initiatives flow from the Policy Framework, including comparative scans and analysis of patient safety legislation in the jurisdictions, the National Pharmacare Strategy and the Self-Care Framework.
Policy Influence and Outreach
During 2018-2019, the Canadian Patient Safety Institute undertook a number of new and innovative initiatives designed to promote patient safety policy with key policy making audiences. These initiatives enabled the Canadian Patient Safety Institute to promote key policy ideas and solutions with policy makers in government and regulators. Examples of our work include the creation of the Policy Legal and Regulatory Affairs Advisory Committee and the Federal Provincial Territorial Government Patient Safety Network – both of which will be instrumental in informing and promoting policy development. In addition, the Canadian Patient Safety Institute launched a new program, ‘Patients at Parliament’, which is designed to connect patients with parliamentarians both in Ottawa and in Members of Parliament ridings.
Working with our patient-led Patients for Patient Safety Canada Government Relations Committee, the Canadian Patient Safety Institute has taken on a more proactive role in both informing and influencing policy direction on specific topics (e.g. plain language labelling, antimicrobial resistance, and opioids).
The Canadian Patient Safety Institute is a member of the Self-Care Framework Task Force. We provide policy input which has guided the creation of a new regulatory framework that includes safety measures for over-the-counter medications and natural health products. In September 2018, the Canadian Patient Safety Institute launched a national e-petition to the House of Commons in support of changes to the Self-Care Framework, which outlines Health Canada’s approach to regulating self-care products, including natural health products, cosmetics and non-prescription drugs. The petition received over 800 signatures and resulted in a commitment from the federal government to include plain language labeling requirements in the Self-Care Framework.
To further support Health Canada’s Advisory Council on the Implementation of Pharmacare, the Canadian Patient Safety Institute hosted a public town hall in Halifax to promote the department’s work of Self Care regulations with the public through a national petition. Each of these programs and initiatives was designed to promote key patient safety policy objectives with specific policy makers and/or the public.
While we are pleased with the outcomes of our work to date, we recognise that there is still significant work to be done in order to advance our patient safety policy objectives with federal, provincial and territorial policy makers. Success is possible when we match the right message with the right audience at the right time. We are looking to build on the success of 2018-2019 by enhancing our suite of policy programs while strengthening our capacity to develop and inform health policy change. We are looking forward to further engaging with provincial and territorial Ministers of Health this fall, with Patient Roundtables scheduled for October and November.
Advisory Council on the Implementation of National Pharmacare: On behalf of the Advisory Council on the Implementation of National Pharmacare, the Canadian Patient Safety Institute hosted Council members Diana Whalen and Camille Orridge at a community engagement session in Halifax. With over 80 residents from Nova Scotia and the Maritimes in attendance, patients, caregivers, academia, students and providers had their voices heard on pharmacare. In addition to hosting the event, the Canadian Patient Safety Institute provided a formal submission to the Council and recommended strengthen commitments to medication safety as a patient safety priority.
The final report of the Advisory Council on the Implementation of National Pharmacare tabled with the Minister of Health included a number of commitments to include medication safety policy as a foundation of a national pharmacare program.
Psychological Safety of Health Professionals: The second victim phenomenon is a real and serious consequence related to healthcare roles. Peer to peer support programs support health professionals who are emotionally traumatized after a patient safety incident. At the start of 2018-2019, the Canadian Patient Safety Institute launched the Creating a Safe Space: Confidentiality and Legal Privilege of Peer Support Programs.
A global environmental scan of peer support programs was conducted in partnership with IWK Health Centre (Halifax, NS). The Canadian Patient Safety Institute collaborated with the University of Ontario’s Institute of Technology to conduct a pan-Canadian survey of healthcare providers’ perceptions when experiencing a patient safety incident.
The Canadian Patient Safety Institute also partnered with the Mental Health Commission of Canada (MHCC) to develop a comprehensive Peer to Peer Support Toolkit of practical tools and resources for healthcare leaders, organizations and policy makers. These resources will be made available on the Canadian Patient Safety Institute website.
Twelve stakeholders from across Canada with expertise in peer support programs were invited to form a Best Practices Working Group. This group developed recommendations for Canadian best practices for peer to peer support programs. The intent is for the various components of this program (global environmental scan, pan-Canadian survey report, guidelines for confidentiality and legal privilege, and recommendations for best practices) to form a comprehensive guidance manual with supporting tools and resources to influence practice, policy and standards.
In 2019-2020 a national webinar series will be launched, Creating a Safe Space: Psychological Safety of Healthcare Workers. The four webinars in the series will run from May to September to showcase the various components of this program.
Useful data and information are essential for improvement. Healthcare organizations are not maximizing the use of current data sets. A better understanding is required of the level of patient safety information that can be extracted from existing databases and how to prioritize and utilize it for improvement.
The Canadian Patient Safety Institute is working to advance patient safety measurement and reporting priorities by further supporting the implementation and use of the Hospital Harm Indicator, in partnership with the Canadian Institute for Health Information (CIHI) and the use and monitoring of standardized definitions for infection prevention and control measures with other pan-Canadian partners, including the Public Health Agency of Canada (PHAC), CIHI, Association of Medical Microbiology and Infectious Diseases Canada (AMMI Canada), HSO, and Infection Prevention and Control Canada (IPAC Canada). With the pan-Canadian adoption and application of standardized definitions, we can help to ensure a consistent approach to how infections are defined, measured and publicly reported, and ultimately advance our overall goal of reducing these infections.
Hospital Harm Indicator and Resource: CIHI and the Canadian Patient Safety Institute have collectively developed the Hospital Harm Indicator. The indicator measures harm in hospitals that is linked to evidence-informed practice that can drive improvement.
Since the 2016 release of Measuring Patient Harm in Canadian Hospitals, CIHI and the Canadian Patient Safety Institute have worked with stakeholders to refine the hospital harm methodology. In April 2019, CIHI refreshed its website to highlight the updated methodology and provide data tables with three years of pan-Canadian data (outside of Quebec) using this new methodology (fiscal years 2014-2015 to 2016-2017). The results include: overall hospital harm rate, counts of the four categories of harm and counts of the 31 clinical groups of harm.
The Hospital Harm Improvement Resource is a compilation of evidence-informed practices linked to each of the clinical groups within the Hospital Harm Indicator to help drive changes that will make care safer. Through research and consultation with clinicians, experts and leaders in quality improvement and patient safety, the Improvement Resource is intended to make information on improving patient safety easily available, so teams spend less time researching and more time optimizing patient care. In 2018-2019, the Introduction and General Patient Safety Quality Improvement and Measurement resources were updated, and five new clinical improvement resources added to the Hospital Harm Improvement Resource.
On June 6, 2018, CIHI with support from the Canadian Patient Safety Institute hosted a webinar on the Hospital Harm Indicator: Hospital Harm: A new look, plus insights on how to use for improvement. Over 150 participants attended the call with great engagement on the topic and questions for the speakers.
Reporting, Learning and Sharing
Global Patient Safety Alerts: Global Patient Safety Alerts is a publicly available online collection of indexed patient safety incidents containing more than 1,500 alerts and 8,000 recommendations from 26 contributing organizations around the world that clearly demonstrates what works. It is searchable, free-to-use tool that provides alerts, advisories, recommendations and trends from a global community to assist healthcare leaders and organizations prevent, respond to and learn from patient safety incidents and risks. All information is available in English and French.
The program aims to promote cross-jurisdictional learning and encourage transparency and a culture of improvement among the global patient safety community. With Global Patient Safety Alerts, contributing organizations demonstrate what works by publicly sharing information about identified patient safety risks and effective strategies and actions to manage these risks to prevent harm.
Building on results and recommendations from an independent evaluation of the program, a multi-year growth plan has been put in place to raise awareness and bolster the profile of Global Patient Safety Alerts to increase both users and contributing organizations; improve the technical functionalities of the tool; and investigate new ways to enhance user experience and integrate with existing reporting, learning and sharing resources. In addition, trend reports and briefings were developed for numerous committees, organizations and stakeholders in Canada and internationally, to inform their priorities and ongoing initiatives. Global efforts and initiatives were also supported for patient safety incident reporting and learning systems.
Leveraging the Global Patient Safety Alerts program the Canadian Patient Safety Institute contributes to global reporting and learning efforts in collaboration with other global leaders. Global Patient Safety Alerts saw a 112 percent increase by users last year, with web visitors from over 100 countries.