When BC Emergency Health Services (BCEHS) set a plan in motion to revitalize their approach to patient safety, the province saw how important it is for an organization to mobilize and build a safety culture from the ground up.

Through a highly coordinated effort, BCEHS quality and safety leaders traveled across the province to establish a shared vision for patient safety. Throughout the 2013 and 2014 National Patient Safety Awareness Weeks, and as part of an Accreditation Mock Survey in the fall of 2014, BCEHS went out across the province to talk about patient safety, accreditation, infection control and the BC Patient Safety & Learning System (PSLS).

The result of their efforts is a patient safety culture that is now becoming embedded across BCEHS with wide acceptance of PSLS as a learning and improvement tool.   

To learn more about BCEHS’ journey I met once again with Ben de Mendonca, Leader, Quality, Patient Safety & Accreditation. Ben was quick to acknowledge the accomplishments of BCEHS – the largest emergency health services provider in North America with 4,000+ employees – and he highlighted why the organization is in such a unique position to influence quality of care across the province.   

Building…then Sustaining Safety Culture

“One of the strengths coming out of this work over the past couple of years is that our front line staff – paramedics, nurses, dispatchers, call-takers –  are coming forward with the desire to be patient safety champions in our organization,” Ben started. “Our staff sees value in the event review process and they want to shape how we deliver care to the people of BC.”

BCEHS teamBen explained that establishing an event review process has been a primary focus for BCEHS, including educating staff on the importance of event reporting and how PSLS can be used to track and trend safety concerns. It wasn’t long, Ben said, before employees who participated in the review process bought into the organization’s new model for patient safety event reviews.

Ben admits this has been a three year journey and BCEHS is still learning as they go, but the result has been a significant change in the approach to patient safety events. Their work is aligned with organizational efforts to become a learning organization, and ensures the ability to respond to patient safety concerns through a non-punitive lens.

“There’s been a significant shift at BCEHS,” he said. “Staff report safety issues much more frequently, which is good from our perspective because it means staff feel more comfortable with the reporting process. And there’s far less emphasis on who’s to blame – conversations focus on the patient and how we must learn from our experiences to improve the services we provide.”

At the same time, Ben was clear that BCEHS is just getting started. He said the organization has put in place a quality committee structure to ensure BCEHS continues to move forward in the right direction.

Emerging Infrastructure

“The focus now is on maturing our quality committees,” Ben said. “The committees are becoming more established and have been designed to ensure oversight of the entire safety event review process. This gives BCEHS a way to see where its strengths are, and also where there might be opportunities to improve.”

According to Ben, an integral part of the quality committees is a physician group that provides guidance around treatment and clinical practice.

Paramedic“Our physician oversight ensures clinical accountability across the organization,” he said. “The Quality of Care Committees review patient safety events as they relate to paramedic practice. This is done at the individual case level as well as at an aggregate level to see if there are trending issues in the different regions of the province. When an issue or trend is identified by the committee or the physician overseeing the committee, a briefing note is drafted evaluating the issue, which feeds a larger infrastructure to review and approve recommendations.”

“By reporting to the BCEHS Provincial Quality Council, quality committees are responsible for honing in on the specific needs of their area, which might be either geographic or program specific.”

“Patient safety concerns trending in one area of the province may not be as significant in another area.”

“The Quality of Care Committees allow the organization to look at patient safety concerns that are region specific as well as create shared learning to improve the standards of our services. For example, in Vancouver preferred destination planning is offered predominantly in large metropolitan areas, so an issue discussed at the committee level might be the most appropriate receiving facility for certain patient populations.”

BCEHS dispatchers“In contrast, in rural and remote areas options for trauma hospitals, stroke management centres or pediatric consults are not as available. The challenge for rural and remote BC might be the long travel times required for speciality services, so the committee might consider patient care strategies for long transports. Inter-facility transfers also bring in different complexities and require a truly collaborative approach to understanding patient safety concerns.”

Ben described the quality committees as an “inter-disciplinary model” where physicians, nurses and operational leaders work together to collaborate with front line staff and discuss how to meet the needs of BC’s residents in the best ways possible.

He also expressed the importance of building strong connections with BC Health Authorities.

Creating Mutual Agreements with Other Organizations

“For our vision to work and be sustainable, we’ve created formal pathways with each Health Authority,” Ben explained.

As the primary organization responsible for inter-facility transfers in BC – often from one end of the province to the other – Ben said relationships with other healthcare facilities is key.

When BCEHS reviews a patient safety event, there is at least one Health Authority interaction, necessitating a strong network of inter-agency relationships.Emergency Department

“We’ve participated in several joint reviews over the past twelve months,” he said. “This is huge. It gives us a common understanding around the spirit and intent of patient safety reviews, which are meant to be non-punitive, non-blaming and system focused. We are learning together to improve healthcare delivery for everyone.”

But, as Ben pointed out, BCEHS employees are stationed across the province, which can lead to other complications.

Communicating with Staff “in the Field”

“One of the challenges we’re facing right now is figuring out the best way to reach our front line staff,” he said. “Sometimes we receive a safety event report and we need more information about the patient, but we have no way of following up with the Reporter if he/she has left an anonymous report.”

That makes “closing the loop” with Reporters and sharing vital feedback to support organizational learning a difficult task – something Ben said BCEHS is trying to improve.

Flight paramedics“We circulate monthly bulletins with PSLS “stories” that include data and event review information as a mechanism for feedback. Further, for every critical event, we post a learning summary on our intranet as a way to provide meaningful feedback to all staff, but these aren’t always effective. With the information coming out electronically over our intranet readership is mixed. The information comes out amongst a sea of other information, so we can’t expect front line staff to spend their time looking for and reading this material during their shift.”

“That’s why,” Ben explained, “We find direct interaction with staff to be the most useful way of getting information out to the front line. But that’s not always feasible, so we’re trying to come up with better virtual solutions to communicate with our paramedics in all areas of the province.”

And that’s not all. Ben said BCEHS is preparing for their first accreditation survey in October 2015. It will be the first time Accreditation Canada has accredited an emergency medical services organization the size of BCEHS.

Preparing for Accreditation 2015!

“We wanted staff to have an idea of what to expect, so we did a full mock-up of the accreditation survey in October 2014,” Ben said. “Seven BCEHS staff went on the road for a week to mimic the accreditation experience. A patient safety review framework is an accreditation standard and it’s well established at BCEHS – we learned a lot from the survey mock-up and it’s helped us to prepare for the real thing this October.”

I’m optimistic BCEHS will be ready. Their commitment to the changes needed to really improve quality is truly tangible and I predict they will continue their drive toward positive change.

I look forward to sharing more about BCEHS as their journey continues.

Ben de Mendonca is Leader, Quality, Patient Safety & Accreditation at BC Emergency Health Services (BCEHS). For more information about BCEHS and their approach to patient safety, please contact Ben at Benjamin.deMendonca@bcehs.ca

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