​By: Maya Sinno, Director, Quality Patient Safety and Patient Experience and Léa Salameh, Senior Communications Consultant, Mackenzie Health

In a recent report published by the Canadian Institute for Health Information and Healthcare Excellence Canada, it was revealed that 1 in 17 hospital stays in Canada involved at least one harmful event. Many of these events are preventable.

Health care professionals operate under very stressful, high-stakes environments. This fast-paced, high-volume setting can lead to preventable errors or near misses that impact patient care.

“Preventable harm is a challenge that hospitals across Canada and the globe face every single day," says Altaf Stationwala, Mackenzie Health's President and CEO. “This can be attributed to multiple factors including human errors, technological challenges and unclear processes and procedures."

To address this universal challenge, in November 2019, Mackenzie Health embarked on a journey to zero harm². The goal of the organization is to avoid preventable harm and worker injuries by embracing a culture of high reliability from the boardroom to the bedside.

The hospital developed a five-part strategy for cultural and process redesign that includes:

1. Engaging leadership.

2. Developing an organization-specific patient safety framework.

3. Monitoring specific quality aims based on high-risk, high-volume, high-cost and problem-prone areas.

4. Standardizing a three-part review process that includes a root cause analysis for moderate and critical patient safety incidents.

5. Communicating progress to staff in real time via unit-specific electronic dashboards.

Over the span of three years, Mackenzie Health increased patient safety incident reporting by 13 per cent while simultaneously decreasing falls with injury by 51 per cent³, pressure injury stage II and above by 50 per cent and central line associated blood stream infections by 41 per cent¹. The five-step approach to transformation allows for substantial improvement in Mackenzie Health's patient safety culture.

“We maintained our focus on safety and quality as a way to mitigate clinical risk in a highly turbulent COVID-19 environment – a time when the system was challenged to deliver basic care," explains Mary-Agnes Wilson, Executive Vice President, Chief Operating Officer and Chief Nursing Executive. “We were also in the midst of opening Cortellucci Vaughan Hospital, initially as a system solution to treat COVID-19 patients, and recruiting large numbers of new staff. Despite all the challenges and changes in our environment, we stood firm in our commitment to safety and have seen substantial clinical success."

Mackenzie Health's zero harm journey includes continuously investing in employees and systems to reduce errors and prevent events that can harm patients and employees from happening.

To accelerate this journey and advance quality and safety in pursuit of patient care excellence, Mackenzie Health made the choice to invest in implementing High Reliability Organizing (HRO) principles – principles used in industries like the aviation and nuclear industries where the stakes are high and errors can lead to catastrophic outcomes. This includes outlining the behaviours and tools needed to continue building on its culture of safety.

“By equipping every single person at Mackenzie Health with reliability and commitment to caring tools, we are ensuring that we provide reliable and consistent care to every patient, every time," explained Altaf Stationwala. “Since embarking on our zero harm journey, we've seen significant improvements across areas of quality, safety, experience and workforce engagement. And this only the beginning."

Mackenzie Health was recently named the winner of the Canadian College of Health Leader's 2023 Excellence in Patient Safety Award. This prestigious award recognizes individuals and teams that are committed to transforming and improving patient safety within a health care environment, through leadership, culture change, quality improvement, patient partnership and innovation.

It is reported that organizations who commit to adopting HRO skills as practice habits can reduce their serious safety event rate by 80 to 90 per cent within a couple of years. Enhancing patient care starts with adopting and maintaining a culture of safety by being open and transparent about current challenges, continuously assessing existing processes and systems that are not optimized for safety, and introducing system-wide changes and practices to support health care professionals preform reliably every time.  

As part of their 2022-2025 strategic plan, Mackenzie Health is focusing their efforts on transforming quality and safety through the pursuit of highly reliable care - a continuous journey that will help the organization to continue to deliver excellent care to its communities. 

References

1. Redstone, C., Zadeh, M., Wilson, MA., McLachlan, S., Chen, D., Sinno, M., Khamis, S., Malis, K., Lui, F., Forani, S., Scerbo, C., Hutton, Y., Jacob, L., Taher, A. (2022). A quality improvement initiative to decrease central line associated bloodstream infections during the COVID-19 pandemic: A “zero harm" approach, Journal of Patient Safety.
2. Wilson, M., Sinno, M., Hacker Teper, M., Courtney, K., Nuseir, D., Schonewille, A., Rauchwerger, D., & Taher, A. (2022). Toward Zero Harm: Mackenzie Health's Journey Toward Becoming a High Reliability Organization and Eliminating Avoidable Harm. Journal of Patient Safety, 18(7), 680-685.
3. Wilson, M., Hacker Teper, M., Sinno, M., Kohlberger, K., Nuseir, D., Chan, A., Palomera-Dinglasan, K., Leon, L., Donaldson, D. Taher, A. (2022). Designing and Implementing a Zero Harm Falls Prevention Program. Journal of Nursing Care Quality, 37(3), 199-205.