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System Factors

In order to keep patients safe, it is essential that we understand the factors that shape both patient safety and incident management, then identify actions to respond to, align with and leverage these factors. They originate from different system levels (inside and outside the organization) and include legislation, policies, culture, people, processes and resources.Ìý

The healthcare system comprises many sub-systems operating at different levels (e.g. outside of the organization, organization and/or program level, point of care), each with specific goals, resources (human, financial, equipment) and processes (formal and informal). Maintaining a system perspective and regularly assessing the sub-systems and their connectivity is critical in identifying how they influence each other, which in turn can inform what actions are needed to strengthen patient safety and incident management.ÌýÌý

Assess key system factors and understand how they relate to patient safety and incident managementÌý

• Outside the boundaries of the organization:Ìý
• public and community awareness of and engagement in patient safetyÌý
• healthcare standards, policies, and Ìý
• healthcare infrastructure and resourcing (fiscal, human, facilities and sites, equipment)Ìý
• education of healthcare providers, labour agreements and workforce trendsÌý
• , societal trends (income, social status, education, employment, housing, culture, etc.)Ìý
• health trends, issues and challenges (e.g. disease outbreaks, population health)Ìý
• political environment (local, provincial/ territorial, national), economic, technological and trends influencing the healthcare industry (e.g. through a analysis)Ìý
• infrastructure, trends, and funding for patient safety research, evaluation and improvementÌý
• trends in other sectors that might intersect with healthcare (e.g. technology, social media)Ìý
• geographic location and regional characteristics (remote vs rural vs urban).Ìý
• At the organizational and program/service levels:Ìý
• Ìý
• leadership team and board level commitment and governance, including their knowledge of patient safety science and best practicesÌý
• visibility and engagement in patient safetyÌý
• how leadership prioritize patient safety – whether it is at the top of meeting agendas and allocated at least 25% of the meeting timeÌý
• organizational leadership’s for patient safety performance, alignment with incentives (formal and informal)Ìý
• included at board and leadership meetings, in decision-making and in the design of care processes and patient safety initiativesÌý
• leadership team stability, experience, and styleÌý
• organizational patient safety cultureÌý
• organizational experience, current with patient safetyÌýÌý
• the organization’s funding and financial status, including infrastructure and technology investment needsÌý
• proactive design or redesign of policies and practices related to safetyÌý
• workforce expertise and skill related to patient safetyÌýÌýÌý
• alignment between patient safety, quality improvement and risk management.Ìý
• At the point of care:Ìý
• patient/family partnership in care and safetyÌý
• team communication, feedback, culture, composition, hierarchyÌý
• staff and patients/families being comfortable and able to report incidents, concerns, successesÌý
• staff competencies, skill, experience, professional requirements regarding patient safety and incident managementÌý
• access to resources to manage safety and incidentsÌý
• staff turnover, staffing levels, protected time for projects.Ìý

Identify actions to strengthen patient safety and incident managementÌý

• Respond – Monitor and anticipate system factors that influence and impact patient safety (e.g. changes in regulations, workforce shortages, changes to health funding), ensure patient safety remains at the forefront of decision-making (e.g. regular updates at key meetings, assigning responsibility to stay informed to key leaders) and take action to respond as appropriate.Ìý
• Align – Use internal and external system factors in assessing priority of patient safety and incident management initiatives. Initiatives that align at different system levels create multiple wins, which will accelerate uptake and spread, and promote best practices known to reduce harm.Ìý
• Leverage – Take advantage of system factors to improve patient safety and incident management (e.g. use Accreditation Canada’s Required Organizational Practices as a lever to implement best practices known to improve patient safety).Ìý
• Partner/collaborate – Work with others to make changes that can positively impact healthcare in your setting; support or endorse the work and successes of others.Ìý
• Advocate – Promote learning from patient safety incident management to shape system factors for the benefit of your healthcare organization and providers, as well as others (e.g. work with advocacy groups to change public policy, engage funders in addressing known safety issues).