HN Summary
• Culture of Zero Harm: Since 2019, Mackenzie Health has led a comprehensive cultural transformation toward “zero harm,” embedding patient safety, transparency, and accountability into every level of the organization through a five-part strategy focused on leadership empowerment, standardized processes, and open communication.
• Measurable Results: Through initiatives such as High Reliability Organizing (HRO) training and Daily Leadership Safety Huddles, Mackenzie Health has achieved a 64% reduction in serious safety events, a 53% decrease in patient falls with injury, and record-high staff and physician engagement rates — clear indicators of sustained cultural and operational change.
• Sustaining Excellence: Guided by its 2025–2028 strategic plan Delivering Today, Building for Tomorrow, Mackenzie Health continues to advance its zero-harm journey by deepening person-centred care, expanding digital decision-support tools, and strengthening patient engagement to ensure compassionate, safe care for every patient — every time.
One in 17 hospital stays in Canada involves at least one harmful event. Whether due to human error in high-stress, high-volume environments, unclear processes or technological challenges, tens of thousands of patients are harmed each year. Reducing these incidents requires more than protocols — it demands a fundamental shift in organizational culture.
At Mackenzie Health, this transformation has been underway since November 2019, when the organization launched its journey to zero harm. With a clear aim to foster a culture of transparency, accountability and continuous improvement, Mackenzie Health implemented a five-part strategy to drive cultural and process redesign.
“Our leadership team moved from principles to practice by introducing system-wide changes,” says Mary-Agnes Wilson, Interim President and CEO at Mackenzie Health. “We knew that to truly improve patient safety, we had to embed it into every level of our organization.”
The five-part strategy included:
1. Empowering leadership to champion a multipronged patient safety approach, supported by robust governance and accountability structures. “Achieving zero harm” became a consistent message across staff communications, campaign materials and leadership engagement.
2. Implementing a local quality and patient safety framework to ensure transparency and accountability, strong learning systems and a commitment of continuous quality improvement with a focus on physical and psychological safety for patients and staff.
3. Setting meaningful corporate quality aims through collaboration with health system leaders, quality improvement experts, patient partners and key stakeholders to strive for evidence based and patient centered care.
4. Standardizing safety event reviews and reporting, reinforcing staff responsibility towards event reporting and operationalizing a three-stage event review process to systematically identify and implement highly effective prevention strategies.
5. Launching a comprehensive communication plan to raise awareness, share real-time results and celebrate successes across multiple channels, including their Staff Forum, team huddles, newsletters and digital signage.
As a nationally recognized leader in patient safety and high reliability — and a recipient of awards like the Canadian College of Health Leaders’ Excellence in Patient Safety Award — Mackenzie Health continues to raise the bar.
In 2022, the hospital system adopted High Reliability Organizing (HRO) principles to further embed safety-focused behaviours and processes. Certified staff led universal HRO skills training courses for all employees and physicians, equipping them with tools to prevent errors and deliver consistent, patient-centred care. “The goal was to empower every single person at Mackenzie Health to provide great care to every patient — every time,” says Wilson.
Daily Leadership Safety Huddles, introduced in June 2023, have become a cornerstone of this culture. Leaders across the organization now report on safety events each day, reinforcing transparency and shared accountability. Staff are encouraged to speak up about safety concerns, near misses and errors — fostering a learning environment where continuous improvement is the norm. By openly sharing near misses and errors, the organization can learn from them and implement changes to prevent similar incidents from occurring in the future.
The results are compelling. Mackenzie Health has achieved a 64 per cent reduction in serious safety events, a 48 per cent decrease in patient complaints, and 13 per cent fewer hospital harm cases than the national average. Central line-associated bloodstream infections have dropped by 46 per cent, and patient falls resulting in injury have decreased by 53 per cent. As of 2025, 96 per cent of staff and 88 per cent of physicians have completed HRO universal skills training, underscoring the organization’s commitment to safety, quality and compassionate care.
“These numbers reflect the cultural transformation we’ve achieved,” says Wilson. “But the real success lies in the collective commitment of every team member.” This shared commitment is also reflected in Mackenzie Health’s highest-ever staff and physician engagement scores, achieved in 2025 — a strong indicator of the positive impact that a culture of safety, transparency and continuous learning can have on the entire organization. Responses from staff shared that the top two drivers of employee engagement were having the opportunity to contribute to patient care and service excellence (83 per cent) and understanding how their role supports Mackenzie Health’s priorities and the communities they serve (81.4 per cent). These strong results are a testament to how each member of the organization has a role to play, while recognizing opportunities for improvement.
Mackenzie Health’s 2025–2028 strategic plan — Delivering Today, Building for Tomorrow — keeps quality and safety at its core. Anchored in Patient Care Excellence, the plan includes an evolution of the zero harm journey, focusing on deepening the organization’s commitment to compassionate, person-centred care. This includes embedding empathy into every interaction, expanding the use of digital tools to support clinical decision-making and enhancing patient engagement through real-time feedback and personalized care pathways.
As Mackenzie Health continues its relentless pursuit of zero harm and high reliability, its experience offers valuable insights for hospitals across Ontario seeking to enhance patient safety. By aligning leadership, empowering staff and embedding safety into every process, a culture of zero harm is not only aspirational — it’s achievable. The path forward is clear: when every team member is engaged, and every voice is valued, safer, more compassionate care becomes the standard.
Elizabeth Megraw, Communications Consultant, Mackenzie Health