A Bold New Strategy: Achieving Safe Healthcare in Canada

1. 2018 – 2013 Strategic Plan

2. A Bold NewDirection VisionStatement: Canada has the safest healthcare in theworld Our Visionof theFuture MissionStatement: To inspire and advance a culture committed to sustainedimprovement for saferhealthcare CPSI’s Role inAchieving theVision Strategy: Lead system strategies to ensure safe healthcare by demonstratingwhat works and strengtheningcommitment How We WillFulfillOurRole Mechanisms toExecute theStrategy

3. Overview Background: • The planningprocess • The case for a newstrategy • The past decade of patientsafety A Bold NewStrategy: • Vision, Mission andStrategy • Mechanisms andtargets • Financial and organizational implications forCPSI

4. The Strategic Planning Process

5. A Case for Patient Safety “It’s obvious, mistakes happen in themedical community. My expectation as a patient is that you don’trun away, that as a doctor you come back and you help me to get betterinstead of closing yourself inyour own insecurityshell.” KapkaPetrov CPSI and partners have produced reports, developed programs for healthcare providers and boards, provided tools, engaged the public and patients, formed coalitions, and waged campaigns to makecare safer. Yet a decade and more later, the overall level of harm remains disturbingly high. Among recentfindings*: • In 2014-15 an estimated 138,000 hospitalizations – 1 in 18 – resulted in harm, a fifth with more than one occurrence. An earlier study estimated that 9.2% of children experience harm while in hospital. • Over 40% of complex surgical patients suffer harm. Patients who suffer harm are four times as likely to die in hospital than those whodon’t. • An estimated 37% of seniors in nine provinces received a prescription for a drug (Beers list criteria) that should not be taken by thispopulation.

6. The Case for PatientSafety • With $8 million to influence a $228 billion decentralized health system, CPSI has built partnerships and awareness of patient safety and developed and disseminated knowledge and tools for improvementincluding: • Canadian DisclosureGuidelines, • Patient safetycurricula, • Safer Healthcare Now!Campaign • National Patient Safety Consortium and a series of initiatives in the National Integrated Patient Safety ActionPlan • Capacity for patient safety in many provinces has grown with the creation of Quality Councils that include patient safety as a key dimension ofquality. • Despite these successes, there are challenges that require CPSI to shift itsfocus: • Recentpapersindicateonlymodestimprovementsandlittlesenseofurgencyaboutpatientsafety • Dataarelimitedwithnoconsistent/comprehensiveapproachtoassessingthemagnitudeof harm • No one has cracked the code on patient safety internationally although a few approaches showpromise: • Scotland’s strong political commitment and focus on a fewpriorities • U.S. regulatory and paymentincentives/disincentives • UK Measuring and Monitoring ofSafety

7. PatientSafety A Bold New Direction

8. A Different Theory ofChange • The last decade has shown that the development and dissemination of knowledge and tools to support patient safety improvement was necessary but insufficient to drive sustainablechange. • A shift is needed from a pure “push” model to one that has both “push” and “pull” dimensions; CPSI will “push” more strategically by focussing on system change, but will also create “pull” by raising the profile of patient safety, setting targets, securing greater commitment from everyone, and reporting toCanadians. • Support is needed for successful implementation of measurable, sustainable patient safety improvement and initiatives need to be evaluated to demonstrate whatworks. • The evidence of what works needs to be translated into standard practices for practitioners and providers at all levels of the healthsystem. • These best practices can then be incorporated into a more robust system of commitment, responsibility and expectations for patient safety inCanada. • Demonstrating what works and strengthening commitment requires a focus on partners with concrete commitment to implementation andevaluation.

9. Mechanisms to Execute the NewStrategy • Implement – Implement safety improvement projects in priority areas to demonstrate whatworks • Evaluate – Embed evaluation in all CPSI activities to assemble evidence of whatworks • Share with Purpose – Develop concrete strategies to share evidence and improvement knowledge • Raise the Profile – Increase the profile of patient safety to raise expectations for improvement • Transparency – Develop a comprehensive framework that addresses rights and obligations for transparency at alllevels • Commitment – Strengthen commitment to safe care through policy, regulation andaccreditation

10. Five Year Business PlanTargets Creating aFoundation • Common baseline measures for key patient safety issues are established and poor and great performers in key areas of patient safety areidentified • All organizations participating in safety improvement projects will demonstrate a strategy to sustain patient safety practices and impact on patient safetyculture • All safety and quality bodies have patientrepresentation • All provinces and territories are contributing alerts into the Global Patient Safety Alerts system, sharing alerts within their jurisdiction, reporting “Never Events” and completing the incident management continuum for all patient safetyalerts AchievingResults • Medication errors are reduced by 50%; beginning in acute care and then home care, mental health, indigenous health, and primary care as better data isavailable • Practices and principles necessary to sustain improvements in patient safety culture are identified, evaluated andshowcased • Canada is in the top quintile on the OECD ranking for patientsafety • The public profile of patient safety has been increased through widely reported progressreports

11. PerformanceMeasurement • Five-year targets have beenachieved. • CPSI will produce a formal logic model to articulate the new theory of change and create a performance measurement framework against which to measure the impact of theorganization. • CPSI will need to expand our evaluation and impact measurement capacity and infrastructure at the corporate and program levels, clearly articulating links between program operations and organizationalobjectives.

12. Principles to GuideImplementation • A sense of urgency and a desire to “Be Bold” will drive theplanning • CPSI will focus more on the provinces, territories and national organizations and align with Health Canada’s priorityareas • CPSI will focus on patient safety outcomes and sustained efforts and apply implementation science and intentionalrigour • The Business Plan will integrate activities across the mechanisms to maximizeimpact • Much of the learning and achievements of CPSI’s previous work will be leveraged to support the new Strategy, but the programs and activities willchange • The Business Plan will incorporate the latest relevant research, frameworks, and best practices • CPSI will focus on more targeted partnerships with others to achieve thesegoals

13. Independent EvaluationRecommendations • CPSI should work to maintain and enhance the profile of patient safety as a priority across the healthsystem. • CPSI should articulate a more focused role and strategic direction for itselfas • a pan-Canadian patient safety organization. CPSI should reflect on how it can best use its resources to contribute to improving patient safety inCanada. • CPSI should re-conceptualize improved patient safety as its ultimate outcome or vision, and articulate a set of more specific long-term outcomes contributing to this ultimate vision for which it should be held toaccount. • CPSI’s strategic choices should be based on, and reflect, one or more fully articulated theories of change, and its logic model should be revisedaccordingly. • CPSI should support the ongoing performance measurement and evaluation of its own activities and initiatives and contribute evidence on what works to improve patient safety.

14. BudgetAssumptionsand Implications • Demonstrating WhatWorks • The number, range, size and the sustainability of the safety improvement projects for lasting impact are dependent on funding and could be increased with a budget increase from HealthCanada • WorkingAssumptions: • Estimated average cost $500,000 - $1M annually for each safety improvement project depending on depth andbreadth • Approximately 50% of CPSIbudget • StrengtheningCommitment • WorkingAssumptions: • PFPSC approximately$500,000 • Approximately 30% of CPSIbudget • CPSI Infrastructure and OtherPrograms • Research, international commitments,etc. • Corporateservices • WorkingAssumption: • Approximately 20% of CPSI budget (currently $2.5M – approx.30%)

15. FundingImplications • The Business Plan will address three levels offunding

16. OrganizationalImplications Implementation of the new Strategic Direction will require the following work to align CPSI organizationalcapacity: • Review and adjust the CPSI business model asnecessary • Build/strengthen capabilities in new fields (e.g. implementationscience) • Review and adapt CPSI’s role in research and education • Strengthen relations with theprovinces/territories • Review and prioritize key Canadian and internationalpartnerships • Review the CPSI governancemodel • Consider potential merger opportunities to strengthen patient safety efforts • Consider whether some current activities such as strengthening provider capacity could be continued on a cost- recoverybasis • Identify new revenue sources