A patient safety and quality culture bundle for CEOs and senior leaders

Thursday, November 30, 2017 – HIROC News

Patient safety continues to be an issue for Canadians. Significant harm occurs in one out of every 18 hospital stays[1] and patient harm accounts for 15% of healthcare costs, generating an additional $2.75 billion/year[2]. CEOs and senior leaders have a role to play in shifting to a culture that is patient-focused and advances the safety of both patients and providers.

The National Patient Safety Consortium, established by the Canadian Patient Safety Institute, broadly defined a need for more education in the area of patient safety. One of the thematic areas that gained focus was the critical role senior leadership plays in ensuring patient safety is an organizational priority.

In response to this call, the Canadian College of Health Leaders and HealthCareCAN co-led and convened a working group of national and provincial partners to take action. The goal – to identify the “requirements for healthcare leadership” in the area of patient safety and facilitate the spread of this knowledge.

The report “Free from Harm”[3] was the inspiration for this work. The authors called for a common set of best practices to develop a safety culture and envisioned a culture bundle, analogous to the bundle of interventions that drastically reduced ventilator-associated pneumonia.

Using a three-part model of safety culture[4], the group developed a CEO and senior leadership bundle for patient safety and quality culture. It integrates key concepts including: leadership, safety and improvement science, high reliability, patient engagement and measurement. This groundbreaking tool includes a checklist of thirteen elements under three headings: enabling, enacting and learning.

The bundle has been validated with Canadian thought leaders including those in academic roles, senior leadership and governance positions. Examples of elements include:
  • CEO/senior leadership behaviours;
  • patient and family engagement/co-production of care; and,
  • safety reporting/management/analysis.
All elements of the bundle must be applied in order to reliably achieve a safety culture.

The bundle was publically unveiled at the Alberta Health Services Quality Summit in October 2017 as part of a National Conversation on implementing safer, more efficient care. HIROC’s own Polly Stevens facilitated the session. Feedback on the bundle was positive with participants saying they felt it was comprehensive and reinforced the roles of CEOs and senior leaders to advance safety culture. The role of incorporating patients across all bundle elements was of paramount importance.

Feedback on the bundle continues to be sought by each of the partner organizations.


[1] Canadian Institute for Health Information, Canadian Patient Safety Institute. (2016). Measuring patient harm in Canadian hospitals.
[3] Berwick D, Shojania K, et al. (2015). Free from harm: accelerating patient safety improvement fifteen years after To Err Is Human. National Patient Safety Foundation.
[4] Singer S, Vogus T. (2013). Reducing hospital errors: interventions that build safety culture. Annu Rev Public Health. 34:373-396.