Each time a person enters a hospital, they entrust their care providers to keep them safe and help them heal. With this level of responsibility, the stakes are high and even seemingly simple errors can prove catastrophic.
While health care organizations are focused on improving patient safety, preventable harm persists and continues to impact patient care. The impact is significant at a system level, with the Canadian Institute for Health Information reporting that Canada’s unintended hospital harm rate increased from 5.4 to 6.0 per 100 hospitalizations from 2021-2022 to 2022-2023
Believing that safe, compassionate care for every patient is the only standard, Mackenzie Health began a journey to zero harm in November 2019. With an emphasis on leadership commitment and support, the organization developed and implemented a five-part strategy for cultural and process redesign that engaged stakeholders at all levels. This set the stage to improve the patient safety culture across the organization.
In 2022, after opening Cortellucci Vaughan Hospital during a pandemic and amidst a global health human resources crisis, Mackenzie Health recognized the opportunity to accelerate this journey by adopting principles of a High Reliability Organization – principles used in high-stakes industries such as aviation and nuclear power, where errors can lead to catastrophic outcomes.
“At Mackenzie Health, we are committed to actively promoting a culture of transparency, accountability and continuous improvement. This commitment has helped us establish a strong foundation of safety and high reliability across the entire organization,” says Mary-Agnes Wilson, Executive Vice President, Chief Operating Officer and Chief Nursing Executive. “We’ve seen that the HRO approach, which teaches skills and behaviours that help prevent human error, foster collegiality and ensure patient-centred care, has positively impacted both our quality of care and the patient experience.”
Results to date
The improvement to patient safety is evident in several key results. Mackenzie Health has reduced its pressure injury rates by 51 per cent, its central line associated bloodstream infections (CLABSI) by 34 per cent and patient falls with an injury have decreased by 41 percent. Since implementing HRO tools and principles, Mackenzie Health has seen a 28 per cent decrease in serious safety events, a 42 per cent decrease in patient complaints and 20 per cent fewer cases of hospital harm than the national average.
Mackenzie Health attributes these positive results to a fundamental cultural shift made possible by the organization embracing a new approach to work. As of September 2024, 83 per cent of all staff and physicians have completed HRO universal skills training. Organization-wide education also includes leader-specific HRO skills training, which focuses on instilling the principles of HRO, promoting a safety-first mindset and ensuring the timely identification and resolution of problems. Additionally, 76 per cent of leaders at Mackenzie Health have been trained on the Just Culture policy. This policy ensures that the organization continues to promote a fair and open environment that encourages learning from errors in a non-punitive way so that everyone feels safe
speaking up for safety.
“One of the most telling indications of the safety-first culture we’re creating is that staff feel more comfortable coming forward with safety concerns,” explains Altaf Stationwala, Mackenzie Health’s President and CEO. “We encourage staff and physicians to openly discuss errors and near misses, as a willingness to report incidents is crucial to learning from them.”
Since 2022, Mackenzie Health has seen a 23 per cent increase in patient safety event reporting while continuing to see a reduction in serious safety event rates. Near miss reporting rates have increased to more than 25 per cent and reporting of employee safety events has increased by nine per cent.
Leadership has played a critical role in reinforcing this safety-first mindset. In June of 2023, Mackenzie Health launched Daily Leadership Safety Huddles, where leaders meet to report on safety events each day. A three-tiered model allows safety information to flow from frontline workers to executives and vice versa, ensuring that operational sensitivity is maintained and safety concerns are promptly
addressed.
With such promising early gains, Mackenzie Health is eager to continue on the journey it has started.
“We’re proud of our accomplishments in the first few years, but our work is certainly ongoing,” says Altaf Stationwala. “As we continue making progress, we’ll continue to share our experience because the more we learn as a collective, the closer we’ll get to the goal of zero harm.”
By Meg Stypa
Meg Stypa is a Freelance Communications Consultant for Mackenzie Health.
