Academic journal article Canadian Public Administration

From Good Intentions to Successful Implementation: The Case of Patient Safety in Canada

Academic journal article Canadian Public Administration

From Good Intentions to Successful Implementation: The Case of Patient Safety in Canada

Article excerpt

This paper applies implementation theory from the public policy and public management literature to the practical issues involved with the development and advancement of the leading ideas driving the patient safety movement within the Canadian health care system. Concern about patient safety has always been a feature of the health care system, but it has achieved much greater prominence over the past five years. There is widespread recognition that preventable errors are causing unforeseen and unwanted harm to patients, adding to the costs of the health care system in a variety of ways and contributing to the further erosion of public trust and confidence in the system. Most of the research and public debate has focused on mistakes and adverse events in the hospital sector, but there is a recognition that problems can arise in all parts of a complicated, sprawling, and dispersed health care system.

If problem recognition is the first step towards improvement, the second step is agreeing on solutions. There is substantial consensus among care providers, health administrators, policy-makers, and health researchers that the solutions to safety problems already exist. Of course, not everyone agrees. Forster, Shojania, and Walraven have argued recently that our knowledge of the causes of adverse events is incomplete and that acting on recommendations without solid evidence may not produce improvements and may damage the credibility of all patient safety efforts. (1) Most people working in the field, however, take the view that we cannot wait for more, and certainly not for perfect research knowledge before we act on patient safety concerns. Action plans have already been developed in a number of countries at the national and sub-state levels. New safety and quality councils have been created to promote research, to stimulate action, and to coordinate activities. Educational and regulatory bodies for the various health professions have become involved. Progress is being made, but despite the availability of good ideas and good intentions, implementation is proving to be more complicated and slower than patient safety advocates consider acceptable.

This paper attempts to apply implementation theory to the world of practice. (2) The analysis is based in large part on a review of the literature, including recent research and government reports on the topic of patient safety, as well as on the author's experience as the first chair of the Board of Directors of the Manitoba Institute for Patient Safety, created in June 2004.

The first section provides a brief overview of the Canadian health care system, which can best be described as thirteen provincial and territorial systems each with its own distinctive features but all involving a decentralized and indirect approach to the governance and delivery of services. The following section focuses on agenda-setting in the policy process to analyse the emergence and content of patient safety agenda. The issues are seen to be multi-dimensional, so implementing reforms to prevent harm to patients and to promote learning from adverse events will involve numerous initiatives ranging across the boundaries of multiple policy systems and organizations. Finally, the paper analyses the obstacles to the successful implementation of the policy ideas for enhanced patient safety and suggests possible ways to deal with those obstacles.

The context of the Canadian health care system

Context matters to how policy issues emerge, are accepted, and are handled on the various policy agendas of government. Health care presents a distinctive policy context. Each of Canada's thirteen provincial and territorial systems is influenced by legislation and finances controlled by the national government. Federal-provincial negotiations therefore represent a highly visible and crucial feature of the health policy process.

The provincial and territorial health care systems are arguably expensive. …

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