From learning culture to safety culture
How we’re using data and encouraging openness to keep Albertans safe
In September 2018, Dr. Lakhani, a cardiologist from Edmonton, bravely shared a story in the College newsletter about missing a significant, but unexpected abdominal finding on a cardiac ultrasound report. His openness, vulnerability and willingness to share his learning from the situation is just one example of a primary tenet of medicine—lifelong learning.
“Mistakes are not something to be ashamed of, mistakes are something we need to share to prevent them from happening again,” says CPSA Registrar, Dr. Scott McLeod. “The more society embraces that we need to be open with mistakes, the further we’ll advance.”
Lifelong learning is embraced in many industries. In Alberta, the onus is placed on individual physicians to demonstrate their ongoing learning and professional development during their permit renewal process.
As we evolve as a profession, however, we need to take this one step further and embed learning into everything we do. By unreservedly embracing a culture of learning in medicine, we encourage doctors to be open about their missteps and errors, using them as a learning tool for themselves and other physicians.
“A learning culture is proving to be beneficial in many industries, it’s not unique to medicine,” says Dr. McLeod. “We know if you’re working in an environment where you’re learning instead of being punished for your mistakes, people do better and the outcomes are better for patients.”
Using data to prevent risk in the first place
Physicians are only human and errors can happen. However, we want to use data collected as a result of prior error to identify potential risks and stop future error from happening. We do this by giving physicians access to tools and resources like MD Snapshot reports, and Group and Individual Practice Reviews (GPR and IPR).
GPR and IPR are two incredibly robust tools that pair physicians with a CPSA assessor to help them evaluate and make intelligent change to their practice. In 2018, we supported 51 individual practices in making measured changes to improve their care. Forty nine group practices were randomly selected to participate in Group Practice Review and almost a third of them have already submitted action plans to enhance their group practice. We expect these numbers to grow significantly in 2019.
These processes take time and self-reflection, but are proven to make meaningful improvements to a physician’s practice.
“We found it helpful to compare ourselves to other clinics and interesting to compare our strengths and weaknesses,” says a GPR participant. “We were motivated to implement changes.”
The data exists—we just needed to collect and share it with our members in meaningful ways. When physicians and group practices have information and data, they can use that information to improve their practices. “We want every physician to feel empowered and motivated to self-assess their quality of practice,” says Phong Van, Director of Assessment and Competency. “In doing so, we’re all being proactive in protecting the quality of care.”
The feedback from program participants has been overall positive, although we’ve worked to enhance our processes with each round of reviews. The groundwork is being laid for similar processes to be developed for specialists. With time, we expect the College will be able to step back and let physicians take a heuristic approach to their learning, guided by CPSA reports like MD Snapshot.