Building safer health systems : strategies used in the institutionalization of patient engagement for patient safety

Background: Worldwide, four out of 10 patients are harmed while receiving health care in a hospital setting, of which 80 % could have been prevented (WHO, 2009; WHO, 2002; Slawomirski, 2017; WHO, 2019). Recent evidence demonstrates that 15 % of total hospital expenditure and activities in OECD countries is a direct result of adverse events, amounting to trillions of US dollars every year (Slawomirski, 2017). According to a Canadian Patient Safety Institute report in 2016, incidents in both the acute and home care settings resulted in additional costs of $2.75 billion each year. Therefore, it is no surprise that investing in the cost of prevention is much lower than the cost of care due to harm. Today, research suggests that patient engagement (PE) can help improve outcomes and reduce the burden on health institutions. However, the use of PE in various strategies to promote PS has yet to be fully integrated across healthcare organizations and systems in Canada, the USA and many OECD countries. Objectives: The aim of this research study is to identify emerging and innovative PE mechanisms and strategies put in place by organizational leaders in leading healthcare institutions after implementation of Bill 10 in 2015, that would allow the institutionalization of PE in the health care system for patient safety (PS). Two specific questions were asked. Research question 1: What are the different PE strategies/mechanisms put in place by leaders in health institutions (CISSS and CIUSSS) to institutionalize PE for PS? Research question 2: What are the innovative practices (strategies, mechanisms) as well as the limiting and enabling factors put in place by institutional leaders in one of the integrated healthcare centers in Quebec (case study) that would allow PE to be fully institutionalized in risk management for the enhancement of patient safety? Methods: The project is a longitudinal descriptive research project by design with interwoven levels of analysis (strategic, organization and clinical) separated into two phases. Phase 1: 1) development of a tool for leaders to assess emerging PE integration strategies implemented in healthcare institutions to enhance PS (Article 1 of the thesis results); 2) collect ongoing emerging and innovative strategies of PE for PS in health institutions (N= 24: 9 CIUSSS, 11 CISSS, 2 non-integrated universities health institutions) across Quebec (Canada) by using the tool created in phase 1, and collect qualitative data through semi-structured interviews with leaders of these health institutions. Phase 2: 3) Analysis of a case study, which started implementing strategies to engage patients for PS (analysis of fall prevention and reduction pilot project by a clinical team integrating a PP) in their health institution was conducted in a long-term care facility. A qualitative data collection approach was used to conduct semi-structured interviews of strategic, organizational and clinical leaders (N = 7) of 40 min to 2 h 30 min each. Observation, as well as internal and external documents analysis was also conducted (Article 3 of the thesis results). Findings: In phase 1: 1) (Article 1 of the thesis results) a tool assessing emerging PE integration strategies implemented in healthcare institutions to enhance PS was created consisting of 82 questions. 2) (Article 2 of the thesis results), seven main emerging/innovative sub strategies of PE for PS were identified and discussed through the process of knowledge acquisition, knowledge sharing, and knowledge preservation at the three levels of governance: clinical, organizational and strategic. In phase 2: (Article 3 of the thesis results), one case study implementing a strategy of fall analysis process by the clinical team integrating a PP for prevention and reductions of falls, was selected to participate (CISSS Montérégie-Est). Three main sub-strategies were revealed in this article. Conclusion: The research study is the first of its kind at a provincial level. Future work should focus on (1) comparative studies between provinces, nations, and their evolution. There is currently an ongoing Pan-Canadian and a Brazilian research project based on the original research project from Quebec’s. In addition, France, have also conducted this study to describe their PE for PS strategies using the tool created in this thesis. Moreover, additional research should focus on (2) collaboration mechanisms and strategies used in the institutionalization of concrete initiatives / innovative practices (case studies) of PE for PS, the role of patient groups, volunteers, as well as compensation models for PE for PS in these collaboration mechanisms and strategies. In addition, more research on (3) best leadership practices to instill a no-blame culture by way of concrete examples (case studies) will be required to implement a safe culture based on practical leadership experiences. Furthermore, moving from a hospital setting, future research should evolve into (4) Citizen’s engagement for safety, especially during these pandemic periods (e.g. Covid-19).

Keyphrases: Health organizations/institutions, Institutionalization, Risk management/patient safety, Fall prevention/reduction, Patient engagement, Strategies/mechanisms/innovative /emerging