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Patient safety tops the agenda at the Winnipeg Regional Health Authority

by admin admin | Nov 01, 2009
Patient safety is not just the flavour of the month at the Winnipeg Regional Health Authority. It is the No. 1 item on the WRHA board’s agenda – and it usually has a human face. The Quality, Patient Safety, and Innovation Committee reviews actual cases of patients who have died because of an adverse event.

Key Messages

The Quality, Patient Safety, and Innovation Committee and the Aboriginal Health Committee are now the main Board committees of the Winnipeg Regional Health Authority, thanks to a re-organization led by Chairman John Wade.

Patient safety, quality and innovation, not finance, are the first items on the Board’s agenda.

The organization has invested heavily in hiring patient safety experts and creating teams to review critical incidents.

Patient safety is not just the flavour of the month at the Winnipeg Regional Health Authority.

Thanks to the commitment of the organization’s Board of Directors and senior management, patient safety is the No. 1 item on the agenda – and it usually has a real face. That’s because whenever the Board’s Quality, Patient Safety, and Innovation Committee meets, members review actual cases of patients who have died because of an adverse event at one of the Region’s hospitals or care facilities.

It’s a powerful means of assessment. “Lots of boards are not very comfortable with this,” says Dr. Rob Robson, the Health Authority’s chief patient safety officer.

Dr. John Wade, a former deputy minister of health, took over as Chairman of the WRHA Board in 2007. Wade, who had previously served as the Chair of the Canadian Patient Safety Institute, re-organized the Health Authority’s board structure to create the Quality, Patient Safety, and Innovation Committee, along with an Aboriginal Health Committee.

“When I became Chair, the Board was like all original hospital boards – it spent most of its time talking about finances,” says Wade. Although financial issues continue to be an important part of the Board’s mandate, Wade wanted to bring his previous experience and lessons learned into the mix. “We decided it was time for a change in governance. In a nutshell, we think the Board’s prime responsibility is to focus on patients and how we can better change the system to serve them.”

Wade organized workshops to educate other Board members about the importance of changing the Health Authority from the top down into a more patient-centred organization. To that end, the Board committees have greater responsibility to review reports from the CEO and senior management. Reports are not discussed by the full Board unless someone who has read them wants to bring forward a specific question. The Board devotes most of its time to discussing patient safety, quality of care, and innovative ways to create the systemic changes necessary to result in true reform.

Since hiring Rob Robson in 2003, the Board has fully supported his work to change the organization’s culture so that patient safety is foremost in the minds of all 24,000 employees. Robson has encouraged such practices as executive walk-arounds, where senior managers at hospitals and other institutions get out on the floor and walk and talk with front-line workers, and safety huddles, where care teams begin and end their shifts with brief meetings to hand over safety issues to the incoming teams.

Increase in reported incidents “a good thing”

According to statistics, about 158,000 adverse medical events take place in Canadian acute care hospitals each year. Close to 60,000 of these are preventable. Armed with this knowledge, and acknowledging also that about 17,000 patients die each year in Canada as a result of adverse medical events, the Health Authority has worked with the Manitoba government to enact legislation that ensures reporting and disclosure of these events.

The Health Authority has put in place an electronic system and database for tracking critical clinical occurrences. However, the initial reporting of an incident is done via a 24/7 operator phone line. Robson believes that live reporting puts the emphasis on the narrative and results in a much richer description of the event.

Review teams then examine all the major events and bring items to the attention of management if action is required. Proceedings are disseminated via Safety Learning Summaries that Robson’s office sends out across the Authority and to other interested health regions and organizations. “We also track recommendations to ensure that there is follow-up,” says Dr. Brock Wright, the Authority’s senior vice-president of clinical services and chief medical officer.

The Manitoba Evidence Act protects the evidence that critical incident review teams discuss, meaning that members can speak frankly without fear that the proceedings will end up in court.

They really encourage us to identify the patient safety aspects of those issues, whenever we're instituting a major change.

As a result of making patient safety a “major corporate priority,” as Wright describes it, reporting of adverse events at the Winnipeg Regional Health Authority has been going up. But that’s a good thing. “We’re encouraging that, because like most jurisdictions, we’re concerned about under-reporting,” says Wright. Robson believes one of the reasons employees are reporting more incidents is that the Safety Learning Summaries demonstrate that the organization is taking their concerns seriously and fixing problems.

Improving patient care through evidence

In addition to an emphasis on safety, the WHRA is also undertaking long-term projects that have spillover effects on patient care. For example, Trish Bergal, director of utilization, conducted a literature review to try to understand why the Health Authority’s new software, designed to track discharge delays that can slow patient flow and clog emergency rooms, was not resulting in decreased lengths of stay for patients. Bergal’s review helped to identify gaps in the system and highlighted the need for greater leadership related to the purpose of using the computer software. As a result, the Health Authority created a three-person clinical resource team that travels to hospital or clinical sites to help staff modify the way they are using the system and change their practices in order to improve patient flow.

Currently, the Board is struggling to decide which indicators truly measure patient safety and quality of care, and how to assess whether the organization is delivering on its goals. Overall though, Winnipeg Health Region Authority’s Board has supported all of the changes its senior managers and staff have made to create a safer, higher-quality environment for patients. “They really encourage us as management, when we bring forward issues, to identify the patient safety aspects of those issues, whenever we’re instituting a major change,” says Wright.

Rob Robson believes the Quality, Patient Safety, and Innovation Committee’s desire to view every Board decision through a patient safety lens is paying off. “They’re a very powerful and activist committee,” he says, “and I think they are going to solidify the priority that’s given to safety throughout our region, and the activities of the Winnipeg Regional Health Authority.”


Dr. Rob Robson
Chief Patient Safety Officer
Winnipeg Regional Health Authority

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Brock Wright and Trish Bergal are fellows of EXTRA – Executive Training for Research Application – a program designed to develop capacity and leadership in optimizing the use of research evidence in Canadian healthcare organizations. EXTRA is managed by CHSRF and supported by a group of partner organizations.


Pass it on! is a publication of the Canadian Health Services Research Foundation (CHSRF). Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of services that improve the health of Canadians. The views expressed herein do not necessarily represent the views of the Government of Canada. © CHSRF 2009