Episode 3 – Chris Power

Since 2003, the Canadian Patient Safety Institute (CPSI) has been advancing patient safety and quality across the country. Meet CEO, Chris Power, who describes what led to these improvements and provides insight on how we can all take part in making health care safer. Transcript: Full episode 24:22 [Soundclip] CHRIS POWER – When we put a face to it, when you can see the person who has been harmed and you understand the impact that that has had on their life, it does change the game for you. [00:12] MICHELLE PRESTON – That is Chris Power, CEO of the Canadian Patient Safety Institute, the CPSI, speaking about the impact of patient safety events, medical errors. As patients, she says we all have a part to play in reducing preventable harm. And if you are a health care provider, she has an important message for you. Stay tuned for more from the leader of one of the most important organizations in the Canadian health care system. I’m Michelle Preston and this is Patient Safety Voices. [Soundclip] MICHELLE PRESTON – Chris, thank you for joining me today. CHRIS POWER – My pleasure Michelle. MICHELLE PRESTON – So I wanted to start off with your personal journey in health care. You’ve had a very interesting and diverse career. You started as a front-line nurse in Halifax. You quickly moved into management positions, later on into VP roles, and of course today you are CEO of CPSI. When you took on your role as CEO, you were quoted as saying, “I want make a difference in the lives of those I have the privilege to serve.” Can you talk a bit about your personal journey in health care, Chris, and describe how patient safety and quality of care became such a focus for you? [01:25] CHRIS POWER – Sure, well you know, I tell people that I feel very, very lucky. I’ve had a great career and lots of people opened doors for me and believed in me, so I do try to give back that way too to people who are coming up through the health care system. But, when I started my career as a nurse, I remember my very first day of nursing, my mother saying to me, you need to treat every person in that bed like it’s your grandmother, or your mother or father or somebody that you love. And you need to be making a difference in their life because they are entrusting themselves to your care. And my mother wasn’t a nurse, she was a teacher, but she was a wonderfully wise woman. And so I took that to heart. And that was how I shaped my whole career in health care is every time I met with a patient or family, every time I cared for one when I was nursing, I looked at them as if it was my family member and so, you know, always wanting to be sure that I was caring for them in the way that I cared. So, in my whole career, that’s really what drove me, was making a difference. I’ve taken that with me through all this time. And certainly now that I am with Canadian Patient Safety Institute people will often ask me did I have some kind of adverse event, or was I harmed in some way or a family member, is that why I came to CPSI, and the answer to that is no. I haven’t had any personal bad thing happen like that, but I’ve certainly seen it happen in the health system. When I was CEO in Halifax there were some things that happened under my watch and all throughout my career. So, those things really have a profound effect on you and it certainly did to me and made me want to be always at, you know, at the cutting edge of making a difference for patients and families. So, in this job at CPSI we’re so focused on creating safe environments for our public, our patients and families, and it is a real gift to be able to do that. MICHELLE PRESTON: What a wonderful story and kudos to your mother for instilling the real values, I think, of providing safe quality care. Moving on now to a new report that came out last October, Measuring Patient Harm in Canadian Hospitals, put out by CPSI and the Canadian Institute for Health Information (CIHI). It says 1 in 18 patients experience harm, 1 in 5 patients have more than one harmful event and some very interesting statistics in the report:

• An estimated 1,600 hospital beds across the country are occupied by a patient who suffered harm
• In 2014-2015, approximately 12.5% of patients with at least one harmful event died in hospital.

So clearly very significant emotional side effects on families, nurses and doctors as well, and I would imagine the costs on the health care system are staggering. You’ve been quoted as saying, “This report is different. We’re linking the measurement to improvement.” So can you talk about how this report is different from other patient safety studies that we’ve seen in the past and how should Canadians interpret the findings in this particular report? [04:24] CHRIS POWER – Yeah, we’re so proud of this work, it took over three years working with CIHI and CPSI to develop this report. And the way that it’s different is typically statistical reports will come out that just show you the metrics of what’s been, and quantifying what the harm is or what the issue is. This time around together we said, you know, it’s one thing to just give people a report but many of the people that we work with across the country said well, you know, you give us a report but then you don’t give us any tools to, how do we make it better? So this time around CPSI’s major role in this particular work was to create an improvement resource. So for every one of the 31 medical indicators that were measured in this particular report, and its only on 31 different indications, so there are lots more we know that cause harm, but on these particular 31, for every single one of those there is an improvement resource. So if you as a person working in the hospital see in your particular hospital that you are not doing as great a job compared to the rest of the country in one particular area, then you can click on the improvement resource for that area and it tells you here’s best practice, here are the ways that you can improve your outcomes for this particular area and that will be a living document so will continue to be updated all along, it’s all online, people can go in and get it. We think that that is really going to make a difference, rather than just stating here’s the evidence and here’s the issue, we’re saying and here’s how you can fix it. So, really a different approach to just putting out statistical reports. MICHELLE PRESTON – Excellent, so go to the website and look for those resources, if you are a health care provider. [06:32] CHRIS POWER – Yeah, absolutely. And if you are the public who are looking at this particular report, I don’t know if the improvement resource…if you are interested you could have a look at that for sure. But, if you are the public, it is the first time in Canada, in fact it’s the first time around the world that the data that is being collected from the discharge abstract database in Canada, with the exception of Quebec and some psychiatric facilities and mental health facilities. We looked at, they looked at all hospitals across Canada. So, it is really the first time that we’ve used data that has already been collected to kind of sift through to find out what the state of patient safety is across the country. So we believe it’s a great report. It will continue to be built upon so we get a little bit more robust. We currently, the report doesn’t allow hospitals to compare against each other, they are compared to a national rate, but stay tuned because that work will continue to come and I think it will be a great resource for us to understand the scale of the problem and then what we can do to fix it. MICHELLE PRESTON – Excellent, and if we also touch on another first for Canada, the Never Events for Hospital Care in Canada. So, never events are defined as patient safety incidents that result in serious patient harm or death that can be prevented by using organizational checks and balances. So, these are things like an object has been left in a patient after surgery and it led to significant harm, or perhaps improperly sterilized medical equipment that results maybe in a patient’s death or serious harm. These are significant patient safety events. Why is it important to have a list like this for hospital care in Canada? How common are these kinds of events and do you have a sense of what efforts are happening to prevent never events in Canada? [08:21] CHRIS POWER – So, this was a really significant piece of work for Canada. This was done in conjunction with Health Quality Ontario and our Patients for Patient Safety Canada, so they were a big part of this as well to have the patient voice in everything we do. Most other countries have a list of never events that hospitals, and typically these are things that happen in hospitals but not exclusively, and Canada didn’t have that. We had not had consensus on what those major things should be that should never happen in a hospital and that the public should know that we’re doing everything that we can to prevent those from happening. So, this was a big deal for Canada to settle on that and we did that through expert panels, through having experts from across the country and patients really participating, deciding what were those top 15 that we landed on, 15 that we needed to be paying attention to. How often do they happen? Well, for many of them thankfully not very often but they still happen, and that’s what the disturbing thing is because there is lots of evidence to suggest that many of these never events are quite catastrophic so people lose their lives. But many organizations didn’t even know, they weren’t keeping track of their never events, they didn’t understand how many they were having. So we have seen really good uptake in this list across the country. There are a number of organizations who are now reporting on their never events very transparently, publicly reporting on those. There are some provinces who are looking at that to say how can they incorporate, is this an area they want to be reporting on on a fairly consistent basis. So we’re really pleased, we’re thankful they don’t happen as often as they have in the past because people are aware of them, but it is a tool that most provinces and territories are now looking at and seeing how they can incorporate those, and track them and measure it to be sure that we are minimizing harm to patients. MICHELLE PRESTON – Well, congratulations on pulling together that report. It’s good to hear those don’t happen often but certainly a significant step in improving patient safety across Canada. I want to touch on leadership now. I don’t think we can focus on patient safety and quality of care without talking about leadership in health care settings. It obviously has a very significant influence on the culture. In the never events list itself it does describe leadership and I’m paraphrasing here, but it says organizations should support and provide an environment where health care professionals feel safe to report and discuss adverse events or system failures. Strong leadership can and should propel this culture. How important is leadership in creating a culture of safety and can you describe what good leadership looks like from a quality and safety perspective? [11:13] CHRIS POWER – So, leadership is paramount. We know this, we know this from lots of different studies that have been put out worldwide to say it is all about teamwork, communication and creating that culture of safety in an organization that is really going to move the bar on patient safety. And so leaders, informally and formally, have roles to play in ensuring that there is safe care every time. But formal leaders really do need to be paying attention to this. And if they take their eye off it, or if they don’t demonstrate that it’s important then that gives licence to everybody else and permission to everybody else to say, ok, perhaps it’s not as important as it should be. So, I’ll give you an example of where, we see some great pockets of wonderful leadership around patient safety around the country here, but one that sticks out for me is at University Health Network here in Toronto. The CEO of that organization, he introduces himself as the Chief Safety Officer, not as the CEO, so he believes that patient safety is job one. And that is permeating through his whole organization as they start to rally around, to try to be a high reliability organization and really be paying attention to patient safety every single step of the way. So, if at a board level your board isn’t having conversations about patient safety constantly, so that governing side of things, that’s hugely important. Your formal leadership from the CEO right through all of your management structure needs to be paying attention to this on a constant basis. And clinical staff as well, that’s what changes a culture. Culture is what you pay attention to. When you see cultures that pay attention, organizations that really pay attention to patient safety you can see it, you can almost feel it in the organization. I was a CEO for a number of years of a health authority, I know there are a thousand things that come across your desk on a regular basis, on a daily basis sometimes. But, if you take your eye off safety for one minute, everybody feels that they have the opportunity or the ability to do that too. So, leadership is critically important around creating that culture of safety. MICHELLE PRESTON – Live it and breathe it and it permeates the organization. I want to go into the patient side of this, you know, the victims of hospital harm. CPSI believes that patient stories are a powerful way to improve patient safety. You have a number of real stories on your website of people who have experienced harm or family members who have had a loved one die, in some cases children, tragic cases. Why is it important for patients to continue telling these stories and how are these stories being used to improve care in Canada in your opinion? [14:08] CHRIS POWER – So, I think it’s vital to have the patient voice in everything that happens in patient safety. We have a program here at CPSI called Patients for Patient Safety Canada, it’s a World Health Organization program, in ours we have over 70 people who have either been harmed themselves or their loved ones have been harmed. A couple of them are just really interested in making a difference and they haven’t been harmed themselves. These folks are phenomenal people, they work with us in everything we do we bring patient voice there. It’s really easy and not as impactful for us as leaders or people working in the health care system to see statistics, to see data. But when we put a face to it, when you can see the person who has been harmed and you understand the impact that that has had on their life, it does change the game for you. So, we’ve done a number of videos as you alluded to Michelle, we’ve got these videos on our website. They’re free to download, we start every board meeting with them. Everywhere I speak I start with a patient video, it sets the tone, it reminds people of why we do what we do. And for the patients themselves or family members who’ve been harmed, they need their voice to be heard because what they want is to be sure it doesn’t happen again and they want to be part of the solution going forward. So, it is absolutely critically important and we do a lot of work with patients and they bring their voice to many different initiatives around the country. I will add one thing though, when harm happens to a patient and families are engaged and patients are, whoever the care provider is or providers who have been involved in unintentionally harming a patient, they become victims too. And so we often forget about that in health care that it’s not only the patient and family who are affected deeply by this, but it is the care provider, whether it’s a physician or nurse or pharmacist or anybody who has been involved in that harm. So, we’re doing some work at CPSI on what we call wounded healers or second victim is the term that’s been coined in the United States by Dr. Albert Wu, and so we’re doing work with him as well to say, how can we in health care organizations support and help these clinicians who have been involved in harm because it is devastating for that to happen. And there probably isn’t one person who has been working in the health care system who hasn’t either made an error themselves or who have observed an error.  And the impact is great on them too. So, no question our focus has primarily been on patients and families and very appropriately so, but I think as organizations and those of us who are working in the health care system can all appreciate we need to be there to support our fellow workers as well who have been involved in harming unintentionally. MICHELLE PRESTON – Absolutely, I actually want to talk about their perspective. It does seem like it has become much more complex today, there’s multiple care providers taking care of one patient at any given time, patients move throughout the health care system, often times they even have underlying health issues that don’t relate to the reason why they’re in hospital, so it can be really challenging I think for health care staff at times. What advice do you have for health care staff who might be listening to this podcast now and looking for some inspiration from you as they go to work every day looking to do a good job, not intending to harm anyone, but dealing with so many multiple priorities, do you have any inspirational words for them? [17:37] CHRIS POWER – Yeah, you know, there is no question that care is so much more complex than it was. I think when I started nursing in the late 70’s it would be unusual for a patient to present with more than two things wrong with them, it really would. And now we are seeing, you know, 6, 7 and even more. The number of medications, the complexity of the care, but never has our care been better. In all of our history, never has our care been better, and we’re focusing on when things go wrong, but I think we do need to remember that, for the most part, things go right. So for anybody listening you need to pat yourself on the back for that. I read a research study one time that said a nurse is interrupted every six minutes. So, when we think about that, we think about the systems that we place around our nurses, physicians, others in that craziness that sometimes feels so frenetic because there are so many things happening. How do you just step back and come to work every day and say, I’m just going to do my best. I’m going to love my patients, I’m going to do the best I can. And that’s my advice, just do the best you can, and care for those around you. Patients don’t remember what you did for them, but they remember how you made them feel. And so I always say to young people, take that to heart, let them understand that you really care about them. They understand you’re busy, they understand that those things have happened, but if they don’t feel like they are important to you and they matter to you, then that’s when you have complaints, that’s when things, you know, kind of go south a little bit. So just always, try to remember that, try to know that they’re watching your every move, they’re listening to every word that you’re saying, and how important it is. Remember what your mother taught you, remember how she taught you to be, to care for people, to be good to others, and that’s often easier said than done but I will tell you that still helps me through my day. And I’m not caring for patients but I’m in lots of different situations, and when I was a nurse it helped me considerably. I think there is an understanding of the immense stress and complexity that’s in the workplace now. It may not be apparent to some people who are working there, but I think people really do understand it, and I know this is one of the toughest jobs there is but also one of the most rewarding. MICHELLE PRESTON – I think patients have a part to play in this as well, right? CHRIS POWER – Absolutely. MICHELLE PRESTON – We hear the term empowered patient, so what does it really mean to be an empowered patient and what advice to you have for patients and families as they move throughout our health care system? [20:22] CHRIS POWER – So, I think we all have a responsibility to be as healthy as we can. There are some people that they can’t help it, right. We understand, and there are vulnerable people and there are some folks that perhaps just aren’t able to manage that. But most of us do have a responsibility to keep ourselves healthy, and when we aren’t healthy and we do need to access the health care system, to truly understand. If we want to be a full partner, and I’ll wear my patient hat now, if we want to be full partners in care then we have a responsibility to do some work too. And so that is to know the questions to ask, make sure that you are asking, make sure you are informed. Know what medications you are on, all of those kinds of things. We’ve developed, in conjunction with Institute for Safe Medication Practices and our patients, five questions to ask your physician or your pharmacist or whoever you are asking about your medications. And there are other resources that are out there and we’ve got some information on our website as well for patients and families to just help you because lots of people say I don’t even know what questions to ask. And we still defer a lot to authority so we think often the doctor knows best, and they know lots for sure, but you know your body better than anybody else does. So really be engaged, be involved, if you are the advocate for one of your family members who is no longer able to do that then really understand. Ask the questions, sometimes that’s intimidating but, you know, it’s changing culture too, and that’s part of it. But come armed with good information and be an active participant in your care. MICHELLE PRESTON – Excellent advice. So important to have an active role in your health care. This has been extremely enlightening Chris. Thank you so much for your insight, it’s been a real privilege talking to you. You have seen patient safety and quality of care become key priorities in hospitals across the country. Any final thoughts on where our health care system is headed? Are you optimistic about where we’re going? [22:28] CHRIS POWER – I am optimistic. You know, when I talk to young people who are now coming out and working I am just blown away by how bright they are and how committed they are, so I have great hope for the future. This is much broader than just hospital care and we’re doing a lot of work in home care because we’re seeing a big move. I mean we’ll always need hospitals, I believe, and we’ll always have to take care of people in hospitals, but more and more the vast majority of care takes place in the community. So we are in the community, working in primary health care and with home care to look at what the patient safety needs are there and working with some hugely wonderful committed partners to make a difference there. I have high hopes for the health system, everybody wants us to be the best we can be. We’ve slipped on the world stage and I think we all want to get back to the top of the pile and there are lots of people working to make that happen. MICHELLE POWER – Chris Power, thank you for joining me today. CHRIS POWER – Thank you Michelle. [Soundclip] MICHELLE PRESTON – We want to hear your thoughts on this topic. You can reach us through our blog, or through Twitter, Facebook, or LinkedIn. We also invite you to visit the CPSI website to watch videos of families who have experienced harm and to download tips and resources if you are a patient or health care provider. Visit www.patientsafetyinstitute.ca. Coming May 5 is a national initiative to promote hand hygiene in health care settings called Stop! Clean Your Hands Day. And October 30 to November 3 is Canadian Patient Safety Week, so please stay tuned for more information about that. Thanks for listening. [Soundclip]