The Ebb and FLO of improving patient safety.

Patient safety in Canada has improved. Yet, dramatic transformation in safety across the continuum of care remains elusive. Front-line ownership (FLO) as outlined by Zimmerman and colleagues represents a novel bottom-up, or "discovery," approach to surmounting the challenges of further improving patient safety. Zimmerman et al.'s rationale and pilot study results suggest, however, that answers to important questions are required prior to the general adoption of FLO. For instance, in FLO's front-line collaborations, what is senior leadership's role? Is it limited to support, or is there a critical role in setting priorities and networking outside organizational boundaries to avoid reinventing the wheel? Who is included in the FLO team? Are housekeepers, doctors and patients all key teammates and contributors to success? In the near term, health organizations' support for FLO should be balanced with more directive safety solutions, within a broad framework that values both evidence-based practice and the generation of practice-based evidence. In this context, the authors of this commentary probe particular dimensions of FLO's theory and practice to promote the best positioning of FLO to enhance its optimal application of knowledge to reduce harm and improve patient safety.

Establishing a global learning community for incident-reporting systems.

BACKGROUND: Incident-reporting systems (IRS) collect snapshots of hazards, mistakes and system failures occurring in healthcare. These data repositories are a cornerstone of patient safety improvement. Compared with systems in other high-risk industries, healthcare IRS are fragmented and isolated, and have not established best practices for implementation and utilisation. DISCUSSION: Patient safety experts from eight countries convened in 2008 to establish a global community to advance the science of learning from mistakes. This convenience sample of experts all had experience managing large incident-reporting systems. This article offers guidance through a presentation of expert discussions about methods to identify, analyse and prioritise incidents, mitigate hazards and evaluate risk reduction.

Reporting for learning and improvement: the Manitoba and Saskatchewan experience.

Both Saskatchewan and Manitoba have embarked on major provincial quality improvement endeavours that include a mandatory reporting and learning process aimed at enhancing patient safety by reducing the potential for recurrence of critical incidents. This move from a voluntary, less comprehensive process signals a commitment from policy makers that substantial improvements to safety will occur only when adverse events are addressed systemically within the healthcare system. Saskatchewan took the lead with the passage of legislative requirements to report, investigate and share learnings arising from critical incidents as of September 15, 2004. Manitoba is due to implement similar requirements in 2006. The focus of legislation in both provinces is aimed at reporting for learning in order to strive for further improvements in patient safety. By empowering staff and physicians to actively participate in risk identification and mitigation, both provinces have become leaders in patient safety. Saskatchewan and Manitoba have taken an innovative and collaborative approach to strive for substantive system changes, seeking out best practices in the areas of quality and patient safety.