A conversation with Cathy Weir, Director, Quality Improvement and Patient Safety at Fraser Health about the importance of effective leadership in the patient safety movement, and for building and sustaining a quality healthcare system. I met with Cathy at the Fraser Health Corporate Office to talk about her background in quality and safety, how Fraser Health has been able to embed a safety culture and her thoughts on healthcare leadership.

I completed my MA in 1994 in adult education so I could apply my clinical knowledge in a way that would broaden my skills and allow me to engage with leaders across the entire healthcare system.

The CEO of my organization at that time had a vision for an integrated healthcare delivery system that resonated with my own personal vision of healthcare – one that brought together all aspects of community health services with a focus on quality and cost – and he invited me to lead the integration of quality improvement into the fabric of the organization. This assignment and my CEO’s mentorship truly marked the beginning of my journey in leading quality improvement and patient safety.

The Institute for Healthcare Improvement (IHI) National Forum in 1994 unleashed my insatiable curiosity about large-scale systems improvement, complexity science and clinical practice variation. Dr. Don Berwick and Dr. Brent James were among the leaders I began to follow, and I became involved with the Board of the Western Healthcare Improvement Network (predecessor to the BC Patient Safety and Quality Council).

When To Err is Human: Building a Safer Health System was released by the Institute of Medicine in 1999, followed by IHI’s 100,000 Lives Campaign in 2004, the patient safety movement was underway in many parts of the world and I wanted to be a part of it here in Canada.

How would you describe the safety culture at Fraser Health?

I feel proud to say that Fraser Health (FH) is on a journey towards a culture where everyone is intentional about their role in promoting safety.  I see areas throughout our organization where staff and physicians are demonstrating innovation and leadership by example, creating an environment of trust where anyone can feel comfortable bringing safety concerns forward without repercussions.

I would say there is a heightened level of consciousness from leadership in supporting people to take an active role in promoting safety.  Our CEO, Dr. Nigel Murray, talks about the importance of patient safety and his personal motto, “What I do matters!” encourages and promotes the idea that a resilient system is vital – for the safety of our patients and for everyone working at FH.

We still have a long way to go, but the journey towards a true patient safety culture is ongoing and FH is committed to this vision. It’s wonderful to see the excellent work going on throughout the organization  and we celebrate our successes whenever we can, such as here on the blog. 

Why, in your opinion, has Fraser Health been able to establish such a strong safety culture throughout the organization?

Dr. Nigel Murray, Fraser Health

It really begins at the top in order to be pervasive. The FH Board is very engaged in quality and patient safety. They establish our strategic focus with patient safety as a key driver across the organization.

Dr. Nigel Murray delivers a constant message of keeping patient safety at the forefront  and, together with the Executive Committee, sets the tone for the organization. I also believe that the BC Patient Safety & Learning System (PSLS) has been a huge driver for patient safety at FH. PSLS data is reviewed at every bi-weekly Executive Committee meeting  – a standing agenda item Dr. Murray calls our “PSLS Prayers” – and this reinforces the value of patient safety data and the Executive’s role in promoting a safety culture. This practice has firmly established PSLS as a tool to support accountability for patient safety throughout FH from the strategic planning level through to everyday interactions between everyone involved in delivering and receiving care.

It’s very influential to have senior executives setting the expectation and leading by example to create an environment where everyone is proud to work, and where patients, clients and residents feel trust, caring and respect at a time when they need us the most.

Where has PSLS had the most impact at Fraser Health?

PSLS has certainly influenced the adoption of a safety culture throughout FH, but there are some areas that especially stand out. For example, the Residential Care and Assisted Living and Medicine Programs are using PSLS to engage multidisciplinary healthcare teams, patients and families in dialogue about how to improve patient safety.  I attribute this to managers who are highly motivated to make healthcare safer and they see PSLS as a valuable resource for doing that.

Tammy Simpson, Fraser Health

Tammy Simpson is our PSLS Coordinator and “Superhero” – she has made PSLS practical, real and accessible to local managers and staff throughout FH.  I believe Tammy’s passion for patient safety and her outgoing, non-threatening approach are the “secret” ingredients to her ability to engage leaders across the organization. The education and support that Tammy provides has really helped our staff to take full advantage of the tools available in PSLS. She helps Programs to incorporate PSLS as part of their monthly quality performance discussions, as well as safety huddles, care planning and staff meetings.

I think of Tammy as a “translator” of PSLS data into the real-life context, which is more meaningful and has a far greater impact for our staff than simply focusing on it as a reporting tool.

What advice do you have for healthcare managers and educators using PSLS as a way to improve patient care?

I would say it’s important to make it real and visible for frontline staff. One of our strategies at FH is to use ‘Quality & Patient Safety’ storyboards so healthcare teams can see what their safety data looks like, what prevention efforts are working and where improvements are needed.

I believe it’s important to be open and to share PSLS data, inviting everyone to participate in dialogue about safety so they can contribute their ideas. Managers, educators, and frontline teams can connect the dots with their everyday patient care experiences, and come up with creative solutions for how to improve safety and quality.

One of the most exciting and innovative ways PSLS is being used at FH is to engage patients and families in shared goal-setting and as a communication tool at care transition points across FH, and with other health authorities in BC.

Practical translation, making the data real, and making it ‘ok’ to not know what to do with the data! – that is where Tammy comes in – and her knowledge keeps patient safety at the local level so what we learn can be brought to the Board and our Executive Committee to influence improvement at the organizational level.

What are the qualities of an effective healthcare leader?

In my opinion, an effective healthcare leader needs to have a commitment to lifelong learning, personal and professional growth.  I believe effective leaders must first be able to lead themselves, taking an inside-out approach to leadership and actively seeking feedback from others in order to continuously improve.

Healthcare leaders must work effectively with others, draw on other people’s skills, expertise and talent and recognize the contributions of others, rather than try to be the expert on everything.  As healthcare leaders, we must be aware of the impact we have on those around us, so self-awareness is critical.

I also think healthcare leaders need to practice with authenticity, humility and a willingness to embrace change. From personal experience, I know that leadership can be very humbling and in a complex industry like healthcare, there is no one leader with the full picture of what’s going on. Healthcare leaders must take notice of everything around them, be willing to ask themselves on a regular basis what difference they are making for the good of the organization – essentially, have a heart-to-heart with themselves!  And also surround themselves with people who have expertise and talent they don’t have and are champions of change.

How do you think healthcare will evolve in the future?

I would like to see everyone working towards a healthcare system where we more fully recognize that we are all in this together. I want our patients, families and care providers to work together to create a system where everyone understands their personal contribution to making healthcare high quality, safe and sustainable for years to come.

With the constant emergence of new and readily accessible technologies, there’s no question that the public will have a much greater role in defining healthcare and setting expectations for how we use our finite resources.

Healthcare is transitioning out of an era where providers are seen as the only experts. Patients will become generally accepted as essential partners – I believe this is a positive and exciting direction for healthcare.

With all the incredible work going on across BC, I feel confident that, together, we are creating a better future for our patients and families. There is much more to be done, but we’ve certainly come a long way in the patient safety movement, not only here at FH, but throughout the province.