https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/10/27/reorienter-notre-approche-seurite-des-patients
Actions you can take to foster safe and inclusive care that goes beyond harm prevention
By Anne MacLaurin
October 27, 2025
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If we want to make real progress in improving patient safety, we need to broaden our understanding of what safety is and shift our approach accordingly. A harm-focused model is simply too limited. Healthcare Excellence Canada’s discussion guide, Rethinking Patient Safety, champions a more holistic, inclusive approach to patient safety.
Editor’s note: Today is the first day of Canadian Patient Safety Week! The theme for 2025 is All Voices for Safer Care. Download Healthcare Excellence Canada’s recent discussion guide, Rethinking Patient Safety, to learn how you can make a difference.
Health care is built on the fundamental belief that every patient deserves safe, reliable care. As nurses and health-care providers, we all strive to ensure the care we deliver is free from harm. But how safe is our care, really? If leadership asked you how safe is the care we provide? how would you respond? And what if patients and their families asked you the same question — what would be your response?
If you’re struggling to answer, you are not alone. Across Canada and the world, we lack a reliable system to monitor the safety of care. We’ve invested countless resources into understanding harm, but we have yet to develop an effective method to measure how safe care truly is. While monitoring and learning from harm is undeniably important, it’s crucial that we realize that the absence of harm doesn’t mean the presence of safety. And perhaps even more critical: measuring past failures is not an adequate predictor of future safety.
In this article, I will review our current understanding of patient safety, propose an approach that goes beyond harm prevention, and suggest actions to foster safe and inclusive care for everyone.
The problem with measuring harm instead of safety
Consider this analogy: if you saw a child running across a busy street, you wouldn’t wait for the child to be hit by a car to assess whether the situation is safe. Yet, in health care, it often takes an incident of harm before we pay attention to safety. This mindset has allowed a culture to develop where safety is reactive, not proactive — and that’s a fundamental problem.
We’ve become fixated on reacting to harm through instituting safety protocols, but that alone cannot deliver the safe care that Canadians deserve. Despite our best efforts, we still face the same risks, and our approach thus far has been ineffective in creating lasting, meaningful safety improvements.
Broadening our understanding of health-care harm
While progress has been made in reporting and learning from harm, there remains a significant gap in fully understanding its extent. Traditionally, patient safety efforts have focused on reducing physical harm related to care, treatments and services — such as health-care-associated infections, falls, or medication errors. However, harm in health care extends beyond the physical to include psychological, social, and spiritual injury.
Furthermore, health-care harm is not limited to those receiving care. Through my work with Healthcare Excellence Canada, I am promoting an expanded understanding of harm that includes recognizing that health-care harm can be experienced by patients, residents, clients and their care partners; clinical and non-clinical staff; and community members across all care settings.
The effects of relying too heavily on individual actions
As a nurse working in patient safety for two decades, I’ve seen firsthand how safety strategies often focus on managing individual behaviours rather than addressing the underlying systems that create risk. Here’s a snapshot of traditional “go-to” strategies for preventing harm:
- Policies, guidelines and checklists: When something goes wrong, we tend to add more rules and protocols, hoping that will solve the problem, without fully considering the systems in which people work.
- Posters and reminders: Safety slogans and messages on walls act as reminders, but often become part of the background wallpaper that are no longer seen.
- Mandatory safety projects: These are often driven from central departments or from leadership, but may not fully consider each facility’s context or engage with those who are actually delivering care.
- Reassurance: We often reassure ourselves and others that everything is fine without truly examining safety issues.
- Blame and shame: When an incident occurs, individuals are often blamed, but the systemic factors that contributed to the event are not fully considered.
Many of these strategies primarily focus on managing individual behaviour, without improving the systems in which care is delivered. Research shows that efforts focused solely on changing human behaviour — such as education, training, and policy adherence — are unlikely to drive effective and sustainable improvements in patient safety (Hibbert et al., 2018). What’s more, I believe this narrow focus on harm and managing individual behaviour contributes to burnout and moral distress, disengagement, and a lack of psychological safety among health-care professionals — creating an environment that is not conducive to real improvement or joy at work.
The solution: a holistic, inclusive approach to safety
If we want to make real progress in improving patient safety, we need to broaden our understanding of what safety is and shift our approach accordingly. A harm-focused model is simply too limited. Healthcare Excellence Canada’s discussion guide, Rethinking Patient Safety, champions a more holistic, inclusive approach to patient safety. It draws on the Measurement and Monitoring of Safety framework, developed by safety experts Vincent, Burnett and Carthey (2013), which provides a more comprehensive way of understanding and practising safety.
Over the years, I’ve had the privilege of working alongside health-care teams across Canada, learning from international experts, and engaging in collaborative efforts that have shown us the true potential of Measurement and Monitoring of Safety. The framework offers five key dimensions of safety that work together as an integrated system.
- Past harm: Has patient care been safe in the past?
- Reliability: Are our clinical systems and processes reliable?
- Sensitivity to operations: Is care safe today?
- Anticipation and preparedness: Will care be safe in the future?
- Integration and learning: Are we responding and learning?
This framework is a game changer. It provides a much broader, more accurate view of safety by focusing not just on past harm but on the systems that enable safe care to happen in the first place. It emphasizes a culture of collective responsibility, where everyone — staff, patients and caregivers — has a role to play in safety.
Everyone contributes to patient safety
The Measurement and Monitoring of Safety framework introduces significant advantages in understanding and improving safety, many of which are reflected in Rethinking Patient Safety . Specifically, the discussion guide highlights the potential of a broader, more holistic approach to advancing safety by:
- Moving away from a narrow focus on past physical harm and toward a more proactive, inclusive approach.
- Encouraging a shared responsibility for safety among all interest holders, from the CEO to point-of-care workers, support staff, families and patients.
- Fostering a practice of inquiry, shifting from assurance reporting to creating space for reflective dialogue, feedback and improvement.
- Emphasising the value of soft intelligence, through listening, observing and perceiving — which are often overlooked in traditional safety efforts.
By adopting the safety framework and applying the principles within Rethinking Patient Safety, we can begin to create a culture of safety that doesn’t rely on policies and checklists alone, but rather encourages curiosity and fosters conversations and ongoing learning.
Start with simple conversations
One of the most powerful ways to improve patient safety is to start the conversation. It might seem simple, but by asking questions and listening to understand, we can identify areas for improvement and build a culture of trust and openness.
Here are some questions that can spark meaningful discussions around safety:
With colleagues:
- What does patient safety mean to you?
- How safe is our care?
- How safe do you feel in our care delivery today?
- How is the presence of safety different from the absence of harm?
- What can we do to create a safe space for open discussions about safety?
With patients and families:
- What makes you feel safe?
- What would make you feel safer?
- Who would you speak to if you didn’t feel safe?
- Has anything alarmed or worried you in the past 24 hours?
These are starting points — small actions that can spark big changes. By asking these questions and acting on what we learn, we can create a culture where safety moves beyond policies and checklists but becomes a shared responsibility that begins with every conversation.
Moving beyond the status quo
Rules or top-down initiatives are not enough to improve safety. We need to create an environment where everyone — health-care providers, patients and caregivers alike — are empowered to contribute to safety. Moving from a reactive, harm-based approach to one that is proactive, reflective and inclusive of everyone’s voice can start with a simple question, and from there, it can grow into something bigger. Together, we can build a system where safety is not just the absence of harm, but a foundational element of everything we do.
References
Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Braithwaite, J., Lomax, S., Prescott, J., Gorrie, G., Szczygielski, A., Surwald, T., & Fraser, C. (2018). Are root cause analyses recommendations effective and sustainable? An observational study. International Journal for Quality in Health Care, 30(1), 1–8. https://doi.org/10.1093/intqhc/mzx181
Vincent, C., Burnett, S., & Carthey, J. (2013). The measurement and monitoring of safety. The Health Foundation. https://www.health.org.uk/publications/the-measurement-and-monitoring-of-safety
Anne MacLaurin, RN, BScN, MN, is a senior program lead with Healthcare Excellence Canada with over 20 years of patient safety experience, offering both point-of-care and system-level insights.
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