HomeTopicsHealth Care PolicyEliminating preventable harm to patients and staff

Eliminating preventable harm to patients and staff

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() has launched an ambitious patient and staff safety initiative that will have a significant impact in making care better and safer across the hospital and also make SickKids an even safer place to work.

SickKids has always been a leader in advancing safe and high-quality care for children and providing a safe working environment for staff. There have been steady improvements in safety at SickKids as a result of various structures and processes that have been put in place and the great work and commitment of its staff. While that effort is having a positive impact on key safety indicators, there are still opportunities to make care even safer and to be even better at learning from preventable safety events.

Through its recent strategic planning process, SickKids has renewed its commitment to safety and quality with a plan that makes “eliminating ” a key strategic focus of the organization. A new safety initiative, Caring Safely, is the driving force.

“Caring Safely is a perpetual effort, a relentless pursuit to eliminate preventable harm to patients and to staff,” says Dr. Mike Apkon, President and CEO, SickKids. “It will enable us to strengthen many things that we already do well and drive further improvements to safety.”


SickKids has set an ambitious set of targets – reducing preventable harm to patients by two-thirds over three years and reducing serious harm to employees by 20 per cent over the same time frame. The ultimate goal is to eventually eliminate preventable harm altogether.

Caring Safely focuses on four priority areas: reducing the occurrence of specific hospital-acquired conditions; reducing the occurrence of serious safety events; enhancing an organizational culture of safety that will build on the first two priorities; and ensuring care is provided in a manner that is safe to staff so that work-related injury and illness are reduced.

For Apkon, safety is really about two things — staying out of trouble by doing things in the safest way possible and by anticipating the various ways that things might go wrong, and getting out of trouble as quickly as possible when something happens that threatens safety. A number of hospitals around the world do this by employing the cultural transformation strategies of other high-reliability industries, such as the airline industry, to significantly reduce harm in their institutions.

High-reliability organizations are preoccupied with how things might go wrong – how people might make mistakes, how communications might be misinterpreted and how things might not work the way they were intended. These organizations endeavour to have people work in a way that is mindful and in the moment – stopping to think very deliberately before taking action and then reflecting on the actions taken to make sure they went as intended. They actively learn from their failures to make sure that similar failures don’t happen a second time.


“We have a strong culture of that kind of learning at SickKids and we will only enhance that as we adopt new approaches to reviewing and learning from events where things didn’t go the way we hoped,” says Apkon.

A big part of being safe, both staying out of trouble and getting out of trouble fast, requires that people feel free to speak up when they see something concerning and that others take notice and pay attention, regardless of who is raising the concerns. As part of the Caring Safely strategy, SickKids introduced new forums for staff to surface any safety-related concerns. One such forum, launched in December of 2014, is the Daily Safety Briefing, where a hospital executive leads managers and directors from across the organization on a daily call to conduct a quick look back at the last 24 hours and a look forward at the next 24 hours to identify any threats to safety. SickKids also introduced a structured approach to patient handoff, the critical point when one health-care provider’s shift ends and a colleague takes over the care of a patient, and now conducts nursing handovers at the bedside so that children and families can raise concerns they might have. These have been great ways to quickly identify problems and find fixes before they cause serious issues.

To advance the rate of improvement, SickKids has joined the Children’s Hospitals’ Solutions for Patient Safety (SPS) Network, marking the first time this network has opened up to a hospital outside of the United States. The SPS network consists of over 85 children’s hospitals that have adopted a high reliability strategy and are sharing safety successes as well as failures transparently. The network is helping them learn from one another, driven by the shared goal to urgently reduce and then eliminate preventable harm for the children in their care.

“The network is not a competition between participating hospitals to see who is the best at patient safety, it’s about all of us being transparent with our data and sharing learnings, so we can eliminate preventable harm,” explains Dr. Trey Coffey, Medical Officer for Patient Safety at SickKids and Medical Lead for Caring Safely. “If you are the best, you teach the rest; if not, you learn from the best.”


SickKids is collaborating with other hospitals in Ontario and Canada to share learning and accelerate efforts related to the safety movement.

“All the work that we are doing around patient and staff safety, all the work that will be done as part of our Caring Safely initiative, all the learning, is a real opportunity for us at SickKids to continue to lead the evolution of paediatric care in Canada and around the world,” says Apkon. “Our ability to transform care will depend on the SickKids team making a collective commitment to embracing this high-reliability mindset but I know this kind of commitment to children is already very much a part of the SickKids culture. Our ultimate goal is to eliminate preventable harm.”



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