Insights (Essays) April 2014

Time for a National Strategy for Patient Safety

Dr. Ben Chan


In its 10-year history, the Health Council of Canada (HCC) served our country well in pushing quality issues onto the agendas of our leaders, managers and policy makers – issues such as wait times, primary care, Aboriginal health and value for money. In its later years, the Council did an excellent job highlighting local innovations in quality in order to help us learn from each other’s successes. Having served as CEO in two provincial quality councils, I greatly appreciated how the HCC brought the provinces together regularly to discuss challenges in implementing quality initiatives and share ideas for moving forward. 

With the end of the HCC comes the inevitable question: what’s next for Canada’s healthcare system and its quality agenda? The Council’s closure coincides with the conclusion of the 2003 Health Accord. This agreement certainly had its shortcomings, such as the reluctance by provincial First Ministers to agree to firm accountabilities for quality, but it at least defined clear national priorities on wait times. Today, our system struggles to define its vision – we have a system with pockets of excellence, but no plan to leverage them, a system where healthcare CEOs regularly tell me they feel pulled in too many directions to be truly effective. Don Berwick, founder of the Institute for Healthcare Improvement, famously declared that “some is not a number, soon is not a time” in exhorting healthcare leaders to set firm targets and timelines. Yet all of us in Canada would be hard-pressed to describe the equivalent aim in our country. 

Certainly, there is natural resistance to setting national targets. Canada has 14 different health systems, one for each province and territory and one for the federal government. Each one jealously guards its decision-making autonomy. Yet we have much to learn from the worldwide experience at goal setting. The UN’s Millennium Development Goals set forward eight targets for maternal and child health, infectious diseases, poverty reduction and education, to be accomplished from 2000 to 2015. Goals were ambitious – typically a 50% decrease in undesirable outcomes. Member states were not held accountable to a central body, but adopted the goals voluntarily because it was the right thing to do. As with all goal-setting activities, some targets will be missed, and many countries struggle with implementation. Progress has been uneven between and within countries, yet there has been substantial progress, such as 700 million fewer people in extreme poverty and a decrease in child mortality from 87 to 51 per 1,000 live births. A strong argument can be made that successes of that scale could not have been achieved without a bold challenge and a clear plan. 

Canada desperately needs its own quality and patient safety goals for the next decade. I imagine a Canada where all 14 jurisdictions adopt stretch targets on excellence in chronic disease management, cancer screening, tobacco and obesity control. I imagine a country where leaders of all acute care institutions commit to cutting by half the avoidable adverse events related to medication errors, falls, pressure ulcers, surgical complications and nosocomial infections. I look forward to a new era where our national organizations – CIHI, Accreditation Canada, CPSI – will push the boundaries on how well their products and services are aligned with each other, in support of a national quality agenda. I want to live in a Canada where provinces will adopt these goals not because they are forced to, but because it is the right thing to do, and they will hold themselves accountable to the job, in service to all Canadians. 

About the Author

Dr. Ben Chan is Assistant Professor in the Division of Global Health and the Institute for Health Policy, Management & Evaluation at the University of Toronto. He served as the inaugural CEO of the Health Quality Councils of Saskatchewan and Ontario from 2003 to 2012, and is currently developing a program of research on quality improvement in First Nations communities. He consults regularly to international governments and the World Bank on quality strategy and development of quality improvement capacity.


 Millennium Development Goals Report 2013. United Nations, New York, 2013. Available at: 



Ashwin Parmar wrote:

Posted 2014/07/05 at 12:31 AM EDT

This is test comment by me. (it works)


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