With their 40-year anniversary around the corner, BC Emergency Health Services (BCEHS) has a long history dedicated to the people of BC. History is an important reminder of the evolution of an organization and for BCEHS, the journey continues.

The transition into Provincial Health Services Authority (PHSA) brought substantial changes to the quality and patient safety infrastructure within BCEHS. The changes have reshaped their underlying philosophy of patient safety and established a patient-centred model that is thriving across the organization.

I had the opportunity to learn more about these new developments with Benjamin de Mendonca, Leader, Quality, Patient Safety & Accreditation. We discussed how the implementation of BC Patient Safety & Learning System (BC PSLS) is part of a culture change movement throughout the organization, how BCEHS is fostering new and meaningful partnerships with BC Health Authorities and how BCEHS senior leaders have re-aligned organizational objectives – all to provide better, higher-quality and safer services to BC’s citizens.

It’s clear when speaking with Ben that BCEHS is passionate about the improvements they’re making. Before we talked about the details, Ben provided an overview of the complexity and scope of the organization:

• BCEHS is responsible for two key service areas: BC Ambulance Service, BC Patient Transfer Network (BC PTN – previously BC Bedline)
• BCEHS responds to 911 requests for ambulance services 24 hours a day, seven days a week and coordinates interfacility transfers across the province of BC
• There are 184 ambulance stations located throughout the province to serve everyone within BC
• BCEHS receives an average of 1,200 ‘911’ calls per day
• There are over 4,000 employees, including paramedics, call takers, dispatchers, nurses and physicians

As a provincial service, BCEHS is in a unique position to establish standards of care and service across BC. The implementation of BC PSLS in 2012 and new governance support by PHSA laid the groundwork for a new, far-reaching quality and safety framework where patient safety is now at the core of everything they do.

A new journey begins!

“This work really began to take shape in the spring of 2012,” says Ben. “That’s when BC PSLS was first introduced to our organization. We started working with a core group of BCEHS leaders and established a patient safety event review process, which didn’t formally exist before.”

Ben says, like with any substantial change, there were growing pains at first. BC PSLS was primarily focused on acute care settings, which didn’t fit the BCEHS business. Plus, as an organization embarking on a new process, they needed to think about…

“Through Plan-Do-Study-Act (PDSA) cycles, our team worked hard over the past two years to get this right. We collaborated with the BC PSLS Central Office team to modify the taxonomy to better suit our needs and we began working closely with key leaders in Metro Operations, Rural Operations, Medical Programs and BC PTN to make the patient safety event review process valuable for the organization.”

Ben says a valuable component of this review process was precipitating new ways to engage with staff when talking about patient safety. Their new process facilitates a different conversation, fostering patient safety culture by focusing the conversation on the ‘patient’ and the organizational processes and systems.

Now, two years later, Ben says standards for patient safety reporting, learning and management have been established across all areas of the organization. They also have a good grasp of volume and type of safety events reported.

“The majority of events we receive are near miss or no harm events, which we analyze and trend. My team is responsible for reviewing safety events that cause serious harm, or Critical Patient Safety Event Reviews (CPSER). We conduct a comprehensive review of the event utilizing a formal incident analysis framework in place across PHSA to learn more, and implement new processes where necessary to safeguard our system.”

Unique to BCEHS is their close connection with PHSA’s Patient Care Quality Office (PCQO), which intakes calls about patient safety concerns from both staff and healthcare partners in addition to care quality complaints. This model uses a central point of reporting, which is well established and creates standards for information collection at the point of reporting.

It all comes down to ‘patient experience’

One strategy is the development of new and different relationships with other care providers in BC.

“We’ve been working hard to establish ourselves as partners with every BC Health Authority, making connections with other quality and patient safety teams. At the end of the day, we are here for our patients and we want to improve. The only way to do that is to look at the entire patient experience – we always need to think of ourselves as part of the healthcare continuum.”

“It’s about changing how we see ourselves,” says Ben. “For example, if we have a familiar face who calls 911 once a week and we continue to respond to that patient, healthcare is obviously not meeting the needs of that individual. The question becomes…how do we work with Health Authorities to better meet the needs of that patient from a healthcare system perspective? Our team is now looking at those collaboration opportunities so we can improve the overall patient experience.”

Can we talk…about patient safety?

Ben is also quick to praise BCEHS senior leaders who are visibly committed to patient safety and quality of care.

“Senior leaders are creating clear lines of accountability for patient safety event reviews. Every layer of the organization, not just front line paramedics, is being encouraged to talk about and work through patient safety events – it’s the way of the future for our organization.”

The adoption of ‘Safety Huddles’ is also helping paramedics feel more comfortable talking openly about safety. The conversations are quick, informal and fluid, keeping the discussion patient-centred.

“Safety Huddles are a way to engage staff. They help to focus the discussion on what matters most – the patient.”

And that’s not all. Ben says Safety Huddles are boosting staff morale in areas where they have become part of the everyday.

“We’re creating a layer of accountability between peers and creating transparency in the organization. The overall culture at BCEHS has shifted tremendously and that’s great to be a part of.”

As our conversation came to a close, I was impressed with all Ben told me about BCEHS. It’s evident that the organization is committed to improving patient safety and providing the best quality care to the people of BC, which is exactly what they’ve set out to do.

Jan Butler, Corporate Director, Quality, Safety, Risk Management & Accreditation, also shared her thoughts on the BCEHS journey, saying:

“The use of BC PSLS within BCEHS to capture information regarding patient safety events has really helped to drive the conversation and shift the culture.  We’re creating common language, consistent tools and encouraging an environment of learning and improvement. It’s exciting to see and feel the changes happening around us.”

Future blog articles will provide more updates as the BCEHS journey continues.