Safety Culture & the Future of Healthcare in Alberta

College of Physicians and Surgeons of Alberta Messenger, Trevor's Take On 1 Comment

Considering all the stuff going on in healthcare (and affecting healthcare) at present, I admit confusion and uncertainty as to the future.

AHS has a new CEO, Vicky Kaminski. She’s agreed to a 3 year contract which, considering the usual tenure of AHS CEOs, may be a tad optimistic but not unrealistic. I wish her well and hope she has her eyes wide open as to what awaits her in Alberta.

AHS continues with the concept of governance housed in an individual, the Official Administrator, currently Dr. John Cowell. Where did this model of governance arise? If this is the preferred model of governance, why is it not more prevalent? Why is it not the model that the “best” healthcare organizations elsewhere have adopted? Can we expect this model for the foreseeable future?

On March 19, Premier Redford announced her resignation, effective March 23. This follows on the recent resignation of two PC members from caucus, a chorus of rumblings from within caucus, and relentless criticism over the Premier’s travel expenses.

While these events are going on, AHS is moving forward on some important projects. By the time you read this AHS will have released its Just Culture policy and the related decision tree for adverse events. AHS has also indicated its intention to include patients and families at every level within the organization, a stunning expression of its desire to become more patient-centered. And AHS has indicated that it will be measuring its safety culture by surveying both staff and medical staff. These are all very positive developments.

Add to this mix the HQCA report on Continuity of Care and the ripple effect it’s having throughout healthcare in Alberta, most recently manifest by the very professional and reflective discussions at the Alberta Medical Association Representative Forum in March. College Council, at its recent meeting, struck a subgroup of councillors to work with staff to draft the CPSA response to the recommendations, to coordinate work with other organizations (such as AMA, AHS and the Alberta Society of Radiologists), and to examine the chronology of events that led to Greg Price’s death from the lens of the medical regulator.

A couple of weeks ago I had the honor to participate in a group assembled by the Royal College of Physicians and Surgeons of Canada to look back at the progress made in Canada on patient safety subsequent to the release of the report from a dozen years ago Building a Safer System: A National Integrated Strategy for Improving Patient Safety. The importance of safety culture (and what we mean by a safety culture) permeated that meeting.

Have we made progress? Unquestionably the answer is yes. But just as clearly we have a long way to go.

A dozen years ago a lot of the terms and concepts in safety were not commonly understood and certainly not commonly applied. In 2014 most healthcare workers are aware of safety principles and recognize the “Swiss cheese” model of error trajectory. That is, however, quite different from applying these principles in our day-to-day work and from working in an environment that embodies these principles.

A quote variously attributed to Paul Batalden and Don Berwick and (even!) Isaac Asimov is important to think about relative to what’s going on in Alberta these days:

Every system is perfectly designed to achieve the results it gets

When we look around at the various ‘systems’ in Alberta and the results they get – whether it’s our provincial political system or our healthcare non-system we should remember these wise words. If we want to get a different result, we’re going to have to change the system (or, in healthcare, implement a real system).

When I think on current events in Alberta I also think of this quotation from Edgar Schein, a former professor at the MIT Sloan School of Management:

The only thing of real importance that leaders do is create and manage culture.

Vicki Kaminski has an uphill battle to change both the culture and the delivery of healthcare in Alberta (will her bosses give her the authority to do so?). I will leave it to others to consider how systems theory and culture may apply to our current provincial political scenario.

As always, I welcome comments from the profession and others. I can be reached at trevor.theman@cpsa.ab.ca or leave a comment below.

Trevor Theman

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David Moores

I thank you Trevor for your thoughtful commentary. However I see Quality and Safety though the eyes of a primary care practitioner with a focus on the whole system. Every day I witness and try and mitigate quality and safety issues related to handoffs/handovers/ and integration. The consultation and referral process is just one of many challenges. Just about every day I’m reminded how community based health services are not even on the radar screen as it relates to AHS and most initiatives.. I’ve witnessed an Ambulatory Care manager at the Royal Alex extol the virtues of a quality and… Read more »