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In preparation for this health summit, we have started gathering resources that provide some background information about current topics related to the BC health system. The provided information and resources are neither exhaustive nor essential but offer some background about a few aspects of BC’s health system. The topics reflect a consultation exercise conducted in February 2021 with more than 600 participants from across BC about health system improvement in BC.
The findings of the consultation exercise revealed consistent priorities among participants and significant opportunities for collective problem-solving regarding:

1. Health human resources

2. Team-based care and the role of the patient in their own care

3. Digital enablers

4. Balancing risk for patients and providers
(You may need to scroll right to see all topics)

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1. Click on the + button to add your resource under the relevant topic
2. Add the name of your resource in the ‘Subject’ line and include any comments about the resource in the section below.
3. Attach the resource using the icons (Upload or Link).
4. Click ‘Publish’ to post your resource.

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To edit or delete your post, hover over the three dots and select ‘Edit post’ or “Delete.” After you’ve edited your post, click “Update.”
If you would like to move your post to another category, drag your post to another column.

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To review resources posted by others, scroll right and down. You can add comments or click "Rate" and select 1-5 stars.

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If you have questions or suggestions, please contact Shelly Keidar, Project Coordinator, UBC Health at shelly.keidar@ubc.ca.
Thank you for participating!

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The Quintuple Aim for Health Care Improvement

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The Quintuple Aim for Health Care Improvement

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This viewpoint paper published in the Journal of the American Medical Association calls to add a 5th aim - advancing health equity to the widely accepted Quadruple Aim for healthcare improvement: improving population health, enhancing the care experience, reducing costs, and improving the work-life of health care providers.

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The Quintuple Aim for Health Care Improvement

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This Viewpoint proposes expanding the quadruple aim (improving population health, enhancing the care experience, reducing costs, and addressing clinician burnout) to the quintuple aim, adding a fifth aim of advancing health equity.

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B.C.’S Health Human Resources Strategy / Putting People First

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B.C.’S Health Human Resources Strategy / Putting People First

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This document delineates B.C.’s Ministry of health’s Health Human Resources Strategy that builds off more than $1 billion committed since 2017 to supporting health-care workers and increasing access to health services. The strategy identifies four cornerstones and 70 specific actions to support a healthy and productive workforce and a better health-care system for everyone in B.C. It also acknowledges and embeds the Province’s commitment to breaking the cycle of systemic and anti-Indigenous racism in health care.

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The Rural Road Map for Action: Directions 

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The Rural Road Map for Action: Directions 

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This document calls upon all those involved in rural health to consider future directions through a social accountability lens. This report is the result of a task force formed jointly by The College of Family Physicians of Canada (CFPC) and the Society of Rural Physicians of Canada (SRPC) in 2014, intending to improve the health of rural Canadians by producing and sustaining an increased number of family physicians practicing comprehensive rural general medicine.

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Team-Based Care webpage on the General Practice Services Committee (GPSC) Website

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Team-Based Care webpage on the General Practice Services Committee (GPSC) Website

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This website offers insight into the current implementation of TBC in British Columbia through the introduction of Patient Medical Homes and Primary Care Networks.

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Access a team of health care providers to support quality care. Download info sheets PMH & PCN: The Big Picture Patient Medical Homes Primary Care Networks PMH & PCN: The Differences or Watch 90-second video BC is working to increase people’s access to primary care by introducing a team-based care…

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Ministry of Health, Team-Based Care Policy Draft – August 2020

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Ministry of Health, Team-Based Care Policy Draft – August 2020

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This document delineates the path toward implementing team-based care (TBC) in primary and community healthcare settings in British Columbia. This document includes TBC principles, the structures and processes needed to support the implementation of the policy, and monitoring and evaluation to facilitate continuous quality improvement and sustainability.

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Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces 

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Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces 

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This academic paper compares the TBC policies in British Columbia, Alberta, Ontario, and Quebec (in 2018-2019) and offers five key components for discussion: patient-centred care; team structures; information systems; financial management; and performance measurement.

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International Journal of Integrated Care

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Article: Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces

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Professional Identity Formation: A Role for Patients as Mentors 

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Professional Identity Formation: A Role for Patients as Mentors 

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This academic paper discusses how patient mentors can help medical students construct their professional identity during the preclinical period by supporting the exploration of and commitment to the professional values that society expects of physicians and viewing patients as an integral part of their healthcare team.

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Professional Identity Formation: A Role for Patients as... : Academic Medicine

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rsity of British Columbia Interprofessional Health Mentors Program (HMP), a longitudinal preclinical elective in which patients, or their caregivers, act as mentors and educate students about their lived experience of a chronic condition or disability. Method The authors interviewed 18 medical re…

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The National Interprofessional Competency Framework by the Canadian Interprofessional Health Collaborative provides an integrative approach to describing the competencies required for effective interprofessional collaboration. Six competency domains highlight the knowledge, skills, attitudes, and values that shape the judgments essential for interprofessional collaborative practice.

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Doctors of BC Policy Statement on Virtual Care 

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Doctors of BC Policy Statement on Virtual Care 

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Pan-Canadian virtual care priorities in response to COVID-19 website 

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Pan-Canadian virtual care priorities in response to COVID-19 website 

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An update on the work of the Federal/Provincial/Territorial (FPT) Virtual Care/Digital Table, including a preliminary policy framework and recommendations for actions and equity in access to virtual care, and provide a summary report of the FPT + Stakeholder Virtual Care Summit.

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Federal, provincial, territorial collaboration

The COVID-19 pandemic has pushed Canadian health systems to innovate quickly, given the significant disruption the pandemic has caused to the delivery of in-person health services. During COVID, virtual care has been key to enabling Canadians to continue to safely access the services they need.

Throughout this time, the Government of Canada has been committed to working in partnership with provincial and territorial governments to put in a range of digital supports to help Canadians get the information, resources and care they need throughout this unprecedented time. On May 3, 2020, the Prime Minister confirmed this commitment by announcing an investment of $240.5 million to accelerate the use of virtual tools and digital approaches to support Canadians. Of this, $200M is helping provinces and territories accelerate their efforts to meet health care needs through virtual tools and approaches.

Following the Prime Minister's announcement, federal, provincial and territorial officials agreed to focus work on three streams.

1. Five shared priority areas for investments in technology and infrastructure

Secure messaging and information-sharing platforms or supports for end-to-end messaging

Secure video-conferencing technology

Remote patient monitoring tools

Patient access to COVID-19 and other lab results

back-end supports for integration of new platforms and supports, including needed hardware

2. Evaluation of the impact of virtual care

3. Policy supports for virtual care

In addition to the federal support to provinces and territories of $150 million, Canada Health Infoway will receive up to $50 million to support provinces and territories in the implementation of new initiatives pursuant to these agreements.

This agenda has been driven by historic Federal, Provincial and Territorial (FPT) collaboration, through a dedicated FPT Virtual Care/Digital Table with a mandate to consider and develop a proposed plan for accelerating the deployment of virtual care in Canada, both during COVID and for the longer term. To inform the work of the FPT Virtual Care/Digital Table, the Virtual Care Expert Working Group ("Expert Working Group"), which includes both stakeholder and government official experts, was struck to provide advice and guidance on issues related to the deployment of virtual care in Canadian health systems.

Policy supports for virtual care

In fall 2020, the FPT Virtual Care/Digital Table endorsed an preliminary policy framework, which identifies barriers and opportunities for the long-term adoption of virtual services within Canada's publicly funded health systems. These policy enablers were categorized into the following "pillars":

patient and community-centred approaches

equity in access to care

provider remuneration/incentive structures

appropriateness, safety and quality of care

provider change management

licensure

The full Policy Framework can be found here: Virtual Care - Policy Framework.

Building off this preliminary policy framework, in January 2021, an external expert, Will Falk was contracted to validate the preliminary FPT policy framework and engage with FPT officials and stakeholders to develop recommendations for actions on virtual care. The resulting diagnostique with recommendations can be found here: The State of Virtual Care in Canada as of Wave Three of the COVID-19 Pandemic.

Equity in access to virtual care was a major theme in discussions at both the FPT Virtual Care/Digital Table and Expert Working Group. Members were seized with the critical importance of ensuring that governments are well-positioned to address/avoid unintended consequences related to equity arising from the widespread uptake and use of virtual care. Led by Dr. Ewan Affleck, an external expert on the Expert Working Group, a Task Team on Equitable Access to Virtual Care was mandated to develop high-level design principles for the consideration of equity in virtual care. The Task Team's comprehensive efforts over the last 18 months culminated in an excellent final report, entitled Enhancing Equitable Access to Virtual Care in Canada.

FPT collaborative efforts on virtual care culminated in a FPT/ Stakeholder Virtual Care Summit on June 22 and 23, 2021. The Summit brought together nearly 80 relevant officials and stakeholders from across the country to discuss the policy enablers underpinning virtual care and to identify considerations for a national action plan to maintain the unprecedented momentum spurred by the pandemic in the delivery of virtual care services. A final summary report, based on the fruitful discussions and key takeaways from the Summit, is available here: Summary Report of the FPT + Stakeholder Virtual Care Summit.

Results

The Centre for Digital Health Evaluation (CDHE) is leading three streams of work with provinces and territories, along with the Canadian Institute for Health Information and Canada Health Infoway, to evaluate the impact of virtual care:

establishing a new digital health evaluation network that includes academics, patient groups, decision-makers, and other stakeholders from all provinces and territories

creating a digital health evaluation framework with standardized methods

conducting two high-impact multi-jurisdictional evaluations of new digital health investments

More information about the CDHE, and its virtual care evaluation work, can be found here: Canadian Network for Digital Health Evaluation.

To enable Canadians to assess progress, the Canadian Institute for Health Information will report the results of this work, based on jurisdiction-specific performance measures.

Bilateral agreements

Following the agreement by federal, provincial and territorial officials on the five priority areas for the federal investments in virtual care, the Government of Canada began multilaterally and bilaterally negotiating virtual care agreements with provinces and territories.

As set out in the agreements, provinces and territories will also provide an action plan within 90 days of signing the agreement, which will set out details of the jurisdiction's specific initiatives for virtual care supported by the federal investments. The agreements and action plans (when available) can be viewed at the following links.

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Prince Edward Island

Nova Scotia

Newfoundland and Labrador

Nunavut

Northwest Territories

Yukon

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Pan-Canadian virtual care priorities in response to COVID-19

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The COVID-19 pandemic has pushed Canadian health systems to innovate quickly, given the significant disruption the pandemic has caused to the delivery of in-person health services. During COVID, virtual care has been key to enabling Canadians to continue to safely access the services they need.

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Virtual Care in Canada: Snapshots of Innovative Virtual Care 

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Virtual Care in Canada: Snapshots of Innovative Virtual Care 

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In this paper, the Digital Health Canada Community of Action (CoA) in Virtual Care presents six virtual care case studies to highlight examples of innovative models of care in Canada, including examples of hospital-, community-, and primary care-based virtual technologies as well as an example of a self-directed and peer support tool. The case studies included lessons learned and recommendations for other organizations looking to implement similar technologies.

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Enablers for Remote Monitoring Programs for Cardiac Conditions: Lessons From the COVID-19 Pandemic 

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Enablers for Remote Monitoring Programs for Cardiac Conditions: Lessons From the COVID-19 Pandemic 

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During the COVID-19 pandemic, Canada’s healthcare system has experienced a dramatic shift toward virtual care. This Policy Insight published in the Canadian Journal of Health Technologies summarizes key facilitators and barriers to implementing and expanding remote monitoring programs for patients with cardiac conditions.

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Digital health for quality healthcare: A systematic mapping of review studies 

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Digital health for quality healthcare: A systematic mapping of review studies 

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The authors of this study have systematically searched, selected, and cataloged review studies on digital health and quality care and summarized key considerations for policy and practice.

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World Health Organization - Global strategy on digital health 2020-2025

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World Health Organization - Global strategy on digital health 2020-2025

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The global strategy aims to create a shared understanding among all WHO Member States regarding the importance of digital health solutions, and an approach towards creating an interoperable digital health ecosystem which is to be understood as a digital interoperable information technology infrastructure that is primarily used by the health care community across all care settings, in particular by health care providers, health service providers and patients as well as by public health authorities, universities and research institutions. An interoperable digital health ecosystem should enable the seamless and secure exchange of health data by and between users, health care providers, health systems managers, and health data services.

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Health Canada Decision-Making Framework for Identifying, Assessing, and Managing Health Risks 

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Health Canada Decision-Making Framework for Identifying, Assessing, and Managing Health Risks 

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This document provides a description of the key challenges which led to the development of the framework, the general principles that underlie the framework, a detailed description of the steps in the framework, and an overview of the considerations that are dealt with in various guidance documents.

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What Is Ethically Informed Risk Management? 

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What Is Ethically Informed Risk Management? 

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This article discusses professional ethics in health care risk management. It frames ethically informed risk management as a patient-centered and evidence-based practice, aligns its scope with that of biomedical ethics, and proposes specific ethical duties to guide risk management practice. It provides a starting point for more robust debate and the development of ethical standards for health care risk managers.

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Journal of Ethics | American Medical Association

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Abstract

Ethically informed risk management includes both the management of ethical risks and the ethical management of risks (professional ethics). This article aims to rekindle dormant discussion of professional ethics in health care risk management. It frames ethically informed risk management as a patient-centered and evidence-based practice, aligns its scope with that of biomedical ethics, and proposes specific ethical duties to guide risk management practice. It provides a starting point for more robust debate and the development of ethical standards for health care risk managers.

Introduction

There are 2 key avenues for applying ethical reasoning in health care risk management: the management of ethical risk and the ethical management of risk. The management of ethical risks (eg, related to advance directives, disclosure of accidental harm) has been the focus of significant attention in the risk management literature. 1,2,3,4,5,6,7,8 The ethical management of risk (ie, professional ethics in risk management) has not been entirely ignored (see especially Kapp ⁹) but has received far less attention and rarely appears to be a primary focus of ethical analysis.

The field of health care risk management has 3 foci, each of which has clear-and sometimes conflicting-ethical implications. It began as an insurance-focused response to the malpractice crisis of the 1970s and soon evolved to include legal and regulatory compliance. By the mid-1980s, its focus had expanded to include tackling clinical and patient safety risks through systems improvement. ¹⁰ Outside the health care context, these 3 functions-risk finance, legal and regulatory compliance, and safety improvement-arose from very different traditions, each with its own ethos, praxis, and literature. 11,12,13 Health care risk management encompasses the 3 in a single chimeric profession. ¹⁴

Among risk managers, only attorneys have the benefit of a widely accepted code of ethics. ¹ ⁵ Neither the strictures nor the freedoms (within those strictures) of legal ethics apply to the rest of the risk management community, however, and while the American Society for Healthcare Risk Management briefly promoted a code of ethics for all risk managers, ¹⁶ it no longer does.

I will therefore focus on nonattorney risk managers. These professionals face significant moral dilemmas in the course of their work and would probably benefit from a code of professional ethics that speaks to their concerns in a relevant and principled way. In part, such a code would help provide clarity in sticky ethical situations, but, perhaps more consequentially, it would provide a potent defense against pressure (from administrators, clinicians, or even patients) to take unethical actions. 17,18 If such a code of ethics were adopted, then-to paraphrase Latham ¹⁸-when you hired a risk manager, you would get the code. It would serve as a de facto part of the employment contract, delineating the scope of action that risk managers would-and would not-take. ¹⁸

It is not possible to construct a code of professional ethics from whole cloth in an article of this length, nor is it a task for a single author. I hope, however, to help begin a conversation about which ethical principles ought to guide an ethical code for health care risk management.

Purposes of Risk Management

On the face of it, risk managers pursue 2 different and sometimes conflicting goals: protecting patients and protecting the health care organization. Tracing the history of health care risk management, one could argue that the driving force behind the emergence of the profession was the need to protect health care organizations from legal liability. ¹⁰ As usual, the truth is more complicated, and the rationale for a profession's birth does not necessarily paint a clear picture of its later life. ¹⁸ Even accepting this premise, however, the need to protect health care organizations would still be just the starting point for analyzing the ethical basis of risk management practice. There are 2 key questions: What socially and ethically desirable purpose is served by protecting the organization? And what does this imply about the ethical duties of a risk manager? It is not enough to say, "My ethical duty is to perform the job I'm paid to do"; the ends served by that work must, themselves, be ethically sound (eg, managing risk for a violent criminal enterprise is unethical because of the organization's role in society).

What, then, is the socially and ethically desirable purpose that is served by protecting a health care organization? It is to serve the mission of health care: to improve the health (or at least the health trajectories) of patients. ¹⁹ Health care organizations also do other things, of course; some are organized to make a profit, and all serve an important role as employers. But those facts are also true of ice cream shops. The special privileges of health care organizations, which allow them to tinker with the mechanics of life itself, are given to them by society because these organizations provide care to improve health.

Thus, to the extent that health care risk management exists to protect health care organizations, it does so in service of a mission to promote and protect patients' health. Risk managers accomplish this mission both directly (eg, through patient safety improvement) and indirectly, by protecting the organization's financial and operational ability to deliver on its mission(eg, loss prevention). ²⁰ The patient-centered outlook derived from the health care mission should be a foundational principle of professional ethics for nonattorney risk managers.

Another purpose of risk managers as risk managers is to deliver excellence and effectiveness in the management of risk. Health care organizations pursue their mission primarily by delivering clinical care; they could as easily employ another clinician rather than a risk manager. To justify that opportunity cost, risk managers must ensure that they deliver the greatest practicable value through their work. Achieving this goal calls for practice that is evidence-based ²¹ and constantly advancing rather than benchmark-based and complacent in the status quo. It also calls for making the most of the unique and specialized skills that the risk management profession brings to the table: systemic risk assessment and participatory systems design. Risk managers should, to the best of their ability, spend their time actually managing risks rather than simply collecting, categorizing, and communicating those risks. By themselves, these activities do nothing to protect the health and safety of patients. It is only by informing the design, implementation, and sustainability of effective solutions that they have any impact on outcomes.

Ethically Informed Risk Management

Here, I propose specific principles that might inform professional ethics in health care risk management. They are not intended as the elucidation of any grand moral theory but rather as the starting point for developing a "practice model" ²² for ethical, patient-centered practice in health care risk management and as a public profession of the standards to which that practice should be held.

I begin by applying to risk management the 4 principles of Beauchamp and Childress, ²³ which play a prominent role in contemporary clinical ethics (see Table). 24,25 Aligning the principles of risk management ethics with those most often referenced by clinicians creates a shared ethical vocabulary and helps establish the legitimacy of the broader suite of principles among patients and other stakeholders.

Beneficence
The obligation to provide benefits, prevent harm, and balance benefits against the risk of harm

Address not only physical and economic benefits or harms, but all other harms, including psychological harm and avoidable suffering. 26,27,28,29

Nonmaleficence
The obligation to avoid actively causing harm ("first do no harm"), as opposed to the broader obligation to prevent harm from being caused

Apart from disclosure/apology and compensation programs, 27,30,31 current literature provides scant support for assessing how risk management practice can inflict (or avoid inflicting) harm.

Justice
An obligation to pursue the fair allocation of benefits, risks, and costs according to morally relevant criteria

Concerns about distributive justice underlie recognition of inequities in patient safety and quality of care32,33,34,35,36,37,38,39,40,41 and apportionment of blamewhen an adverse event occurs.42,43,44

Concerns about procedural justice have been addressed through the just culture 45,46 approach, in which staff are not blamed for problems attributable to their work systems.

Concerns about restorative justice underlie disclosure/apology and compensation programs.27,30,31

A duty to (1) refrain from attempting to control and constrain the autonomous actions of others and (2) actively support autonomous decision making, especially by disclosing relevant information.

Risk management literature addresses support for clinicians and health care organizations in deciding how heavily to weigh patient autonomy in health care decision making. 3,5,9 For risk managers, respect for autonomy also pertains to interactions with the health care workforce, which has received far less attention.

These 4 principles represent prima facie duties, which means they are binding obligations except when they conflict with one another-in which case, a balance must be struck between them (eg, balancing beneficence and autonomy in the case of a minor who requires a blood transfusion that is proscribed by the parents' religion). Unfortunately, there is no checklist or algorithm to ensure the "right" balance is struck. If all ethical duties cannot be perfectly satisfied, the risk manager must attempt to find a solution that best satisfices ⁴⁷ ( sufficiently satisfies) those requirements in context.

Additional Principles

In the context of biomedical ethics, Beauchamp and Childress argue that the 4 principles (along with a few simple rules, such as truth telling) are a sufficient basis for moral reasoning. ²³ Even within the systems-focused realm of health care risk management, one could probably use these principles to infer and justify each of the additional principles I will discuss below. In the context of supporting a practice model for risk management ethics, however, it is probably worth highlighting these more specific duties. The principles below are proposed as a supplementary set of prima facie obligations, with the aim of specifying key aspects of the 4 principles to better develop what Beauchamp would call the particular professional morality of health care risk management. ⁴⁸

Patient-centered practice. As I argued earlier, the ethical duties of risk managers ultimately rest upon the foundation of the health care mission: to improve the health trajectories of patients. Everything else flows from this mission. Because risk managers' scope of practice encompasses the systems level and not just dyadic interactions, patient-centered practice includes respect for the needs of patients in the aggregate (ie, the population of patients served by the organization's mission) as well as the particular patients and families involved in any given situation. Similarly, because risk managers sit at the intersection of clinicians, administrators, patients, and families, they owe ethical duties to all of these stakeholders. The principle of patient-centered practice offers important guidance on how risk managers should uphold respect for autonomy, beneficence, justice, and nonmaleficence by explicitly privileging their ethical duties to patients.

Participatory design. Risk management is, at its heart, a design discipline. Its purpose is to design (or redesign) systems to reduce negative risk and leverage positive risk (ie, potential opportunities) in the service of the health care mission. Current practice focuses primarily on risk assessment (problem exploration), leaving risk control (the design of interventions to improve outcomes) as an afterthought. This oversight leads to predictable and-given the alternatives-frankly unethical failures of the risk management process, especially with regard to patient safety risks. 49,50,51,52,53,54,55,56,57,58 Because health care organizations are complex adaptive systems characterized by what Plsek and Greenhalgh refer to as "individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents," ⁵⁹ the intervention design process can only hope to be safe and effective if it is informed by stakeholder participation (including that of patients ⁶⁰ as well as staff).

What, then, is the socially and ethically desirable purpose that is served by protecting a health care organization?

In addition to ethical motivations related to outputs and outcomes, participatory design (or co-design or co-production) is also motivated by the ethical implications of design as a process (eg, procedural justice and respect for autonomy). 61,62,63,64,65 As Robertson and Wagner state: "Perhaps the core principle of Participatory Design is that people have a basic right to make decisions about how they do their work and indeed any other activities where they might use [the products of design]." ⁶⁵ In health care risk management, self-determination implies a need to include the voices of patients and families who have historically been excluded from the design process ⁶⁰ and also to genuinely engage with staff in the design-not just the implementation-of interventions.

Competence, diligence, and evidence-based practice. Risk managers have an ethical obligation not only to do good, but also to do good well. Failures of competence and diligence have real impacts on the health care mission that, at a minimum, have implications for justice, beneficence, and nonmaleficence. Health care risk management practice has been built primarily on good intentions, expert opinion, and (often underexamined) consensus standards of practice rather than on evidence ⁵⁸-a foundation for practice that is no longer seen as morally acceptable in other areas of health care. ⁶⁶

To meet their obligations under this principle, risk managers must move toward a practice based on evidence and excellence. Examples of practice changes that might support this principle include adopting evidence-based approaches for risk control, 50,51,57,58,67,68 adopting proactive disclosure and settlement, and reducing or deimplementing 69,70 practices that have not proven effective, such as overuse of retrospective risk assessment at the expense of prospective risk assessment 54,71,72,73,74 or excessive focus on categorizing and reporting risks in ways that do not inform action. 75,76,77,78

Respect for privacy. Respect for privacy is well-integrated into risk management practice-so much so that the code of silence can cause risk managers harm. ²⁹ This principle remains worth mentioning, however, because it is important to public acceptance of risk management and because risk managers should be reminded to consider risks to patient privacy when new sources of risk (eg, emerging technologies) 79,80,81 present themselves.

Equity. Equity is clearly implied by the principle of justice, but pervasive inequities in the distribution of patient safety risks, benefits of improvement initiatives, 32,33,34,35,36,37,38,39,40,41 and the burden of blame in safety investigations (eg, preferentially blaming lower-status members of the clinical team) 42,43,44 warrant the recognition of a stand-alone principle.

Honesty and transparency. Finally, risk managers should aim for the highest practicable level of honesty and transparency. Although a duty of honesty is likely to be noncontroversial, the loss-prevention aim of risk management might cause some to balk at a duty of transparency due to a belief that disclosing patient harm or ongoing risks (whether to patients or staff) might cause harm to the organization. Nevertheless, respect for autonomy (of both patients and health care workers) dictates that risk managers enable informed decision making by being transparent about risks and actual harms. Fortunately, these 2 aims-honesty and transparency, on one hand, and loss prevention, on the other-are not necessarily at odds, as demonstrated by the industry's experience with programs aimed at proactively disclosing and apologizing for adverse events and offering compensation to those affected. 7,30,60,82,83,84

Conclusion

The practice of health care risk management is a constant exercise in balancing ethical duties and their conflicts. Currently, risk managers face these dilemmas alone, without the support of an agreed-upon set of ethical principles, much less a formal code of ethics. This circumstance might make risk managers less effective in defending ethical decisions, which not only impairs their ability to support the health care mission but also can lead to a sense of futility and ethical failure. ²⁹ This paper does not attempt to develop a formal code of ethics, but it does propose an ethical foundation for risk management practice and hopefully will rekindle the discussion of what constitutes ethically informed risk management.

Editor's Note

Background image by Ryoko Hamaguchi.

Citation

AMA J Ethics. 2020;22(11):E965-975.

DOI
10.1001/amajethics.2020.965.
Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Author Information

Alan J. Card, PhD, MPH, CPHQ, CPHRM is an assistant professor in the Department of Pediatrics at the University of California, San Diego School of Medicine. His research focuses on risk management, patient safety, quality improvement, and patient and health care worker well-being, with a particular focus on the frameworks, tools, and techniques that shape practice.

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What Is Ethically Informed Risk Management?

# data[].attributes.attachment_link.description
Ethically informed risk management includes both the management of ethical risks and the ethical management of risks (professional ethics). This article aims to rekindle dormant discussion of professional ethics in health care risk management. It frames ethically informed risk management as a patient-centered and evidence-based practice, aligns its scope with that of biomedical ethics, and proposes specific ethical duties to guide risk management practice.

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Patient-Focused Benefit-Risk Analysis to Inform Regulatory Decisions: The European Union Perspective 

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Patient-Focused Benefit-Risk Analysis to Inform Regulatory Decisions: The European Union Perspective 

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This article describes how patient preferences are currently being considered in the benefit-risk assessment context, and shows how different methods of preference elicitation are used to support decision making within the European context.

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Patient-Focused Benefit-Risk Analysis to Inform Regulatory Decisions: The European Union Perspective - PubMed

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Regulatory decisions are often based on multiple clinical end points, but the perspectives used to judge the relative importance of those end points are predominantly those of expert decision makers rather than of the patient. However, there is a growing awareness that active patient and public part…

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A Knowledge Translation (transfer) resulting from the collaborative work of academics at UBC, UNBC and community partners to discover primarily via Photovoice, focus groups,and interviews the conditions in Northern British Columbia from the following prompts:
1. What helps make you healthy in your community?
2. What are the challenges to achieving a healthy life?
This publication was written with the intention to make the result available to the people in the study region, and copies were made available to public libraries large and small in Northern B.C.
https://valemount.bc.catalogue.libraries.coop/eg/opac/results?query=Through+a+Northern+Lens&qtype=keyword&fi%3Asearch_format=&locg=24&detail_record_view=1&_adv=1&page=0&sort=

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How we work as a team and communicate with each other are essential elements of a healthy culture. Improving non-technical skills such as how we communicate, how we respond to the environment around us, and how we work together in a team are crucial for achieving high quality patient care.

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How we work as a team and communicate with each other are essential elements of a healthy culture. Improving non-technical skills such as how we communicate, how we respond to the environment around us, and how we work together in a team are crucial for achieving high quality patient care.

We offer a free and interactive 15-week Action Series that focuses on skills and tools to improve teamwork and communication on your team. In the first four cohorts of the Action Series, over 140 teams have participated, with over 950 total participants from across BC and the Yukon!

Cohort 5 Information Session

Resources

Curious about what the action series involve? Check out the resources from previous cohorts! You will find slides, action period guides and supporting activities and reading. Webinar recordings are only available to past participants. If you completed the action series, please email culture@bcpsqc.ca to ask for the password.

ATTIC Card Resource
Culture Change Toolkit Resource
Worksheets

About the Action Series

Evaluation

In response to ongoing requests from teams in British Columbia's health care system, we launched the third and fourth cohorts of its Teamwork & Communication Action Series in March 2019 and October 2020, respectively. We have been evaluating the series to measure this improvement.

Learn more about what our participants have taken away from the Action Series in our Cohorts 3 & 4 evaluation:

Read Our Cohorts 3 & 4 Evaluation

The Teamwork & Communication Action Series began with the aim of improving teamwork and communication within the BC health care system. We have been evaluating the series to measure this improvement.

Learn more about what our participants have taken away from the Action Series in our Cohort 2 evaluation:

Read Our Cohort 2 Evaluation

The purpose of evaluation reports below is to examine participant feedback and pre-post outcomes of the each cohort of the Teamwork and Communication Action Series offered by the Council, as well as to understand key lesson. Ultimately, these evaluations seek to answer the following questions:

Did the content and delivery of the Action Series provide value to participants?

What immediate impact did the Action Series have on the way they work together, communicate, navigate conflict, and trust each other?

What improvements could be made to the structure of the Action Series which could be utilized for future Action Series?

Read Our Cohort 1 Evaluation

Resources You Might Be Interested In...

BC Health Quality Matrix
Posted in Advance the Patient Voice, Communication, Council Resources, Cultural Safety & Humility, Culture Improvement, Engaging People in Quality (EPIQ), Improve Clinical Care, Improve Culture, Patient Engagement, Quality Improvement, Sharpen Your Skills, Teamwork & Communication on February 26, 2020

See More Resources

Topics you might be interested in...

Clear

Clear is a voluntary initiative that supports long-term care homes to reduce the number of residents who are prescribed antipsychotic medications.

Releasing Time to Care

RT2C provides participating organizations with an opportunity to engage point-of-care staff in leading change to improve care for patients, clients or residents.

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Teamwork & Communication Action Series / BC Patient Safety & Quality Council

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Font Size: Smaller* Larger How we work as a team and communicate with each other are essential elements of a healthy culture. Improving non-technical skills such as how we communicate, how we respond to the environment around us, and how we work together in a team are crucial for achieving high quality patient care.

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Having conversations about what matters is a great way to build the trust and connections which form the foundation of person- and family-centred care.

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What Matters to You? / BC Patient Safety & Quality Council

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“What matters to you?” is a simple question that can have a big impact on care.

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Team-based care is a model of health care delivery where many health professionals work together to support a patient’s needs. A key feature is having patients and their care providers be equal partners.

Implementing this model is a priority in British Columbia, but we know it means a new way of working for many of the people involved. This website features resources and events that can help, whether you’re a patient, planner or care provider, and whether your team-based care journey is just starting or well on its way.

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Looking for resources and information?
Click on one of the roles above to learn more about team-based care in BC

Are you aware of a current gap in learning needs, or know of a tool or resource that is not currently available through our website? Or are you looking for something in particular, and have not been able to find it?

We are working to build a systematized approach for team-based care learning in the province and would appreciate hearing from you. Please email our new learning needs collection portal at learningneeds@teambasedcarebc.ca, or visit our resources page to submit a resource today.

Creating Team-Based Primary Care

Team-based care is a model of health care delivery where many health professionals work together to support a patient's needs. A key feature is having patients and their care providers be equal partners.

Implementing this model is a priority in British Columbia, but we know it means a new way of working for many of the people involved. This website features resources and events that can help, whether you're a patient, planner or care provider, and whether your team-based care journey is just starting or well on its way.

Photo courtesy of the BC Patient Safety & Quality Council
Team Up! Team-Based Primary & Community Care in Action

This webinar and podcast series aims to connect individuals and teams, identify tools to apply to current work underway, and share experiences in team-based care across the province. Find all the recordings from past sessions below.

Featured Events

On February 15, join this webinar to explore the Plan-Do-Study-Act (PDSA) cycle as a problem-solving tool used to test whether a change is an improvement. We'll be learning about each stage of the PDSA cycle and its importance in measuring small tests of change in improvement work.
Register Now

As PCN communities move towards implementation, the Ministry of Health is working in collaboration with the FPSC, PSP, BCPSQC and the ISU to develop and refine new and existing supports for Primary Care Teams. To build coaching capacity in communities to support the transition to Team Based Primary and Community Care (TBPCC), the ISU will be offering Virtual Team Mapping Facilitation Training on February 15 and 16 as well as mentorship to interested participants.
Register Now

Have you ever wondered what supports are available for teams who are shifting towards interdisciplinary care in BC? Did you know there are a range of coaching supports available - each with a different focus area? Team-based care coaches are vital in setting primary care teams up for success. Join us as we hear coaches share stories of working with distributed (dispersed) teams across BC. This session will explore team development, communication and functional changes that need to happen at the practice level.
Register Now
Who Guides Team-Based Care in BC?

The Team-Based Care Advisory Group is made up of stakeholders from throughout the health care system, and guides work across the province to accelerate its transition to team-based care. The group provides systems of support for local action to advance high-quality, person- and family-centred and collaborative care that provides the right care, at the right time and in the right place, in a sustainable system.

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Looking for resources and information?Click on one of the roles above to learn more about team-based care in BC Are you aware of a current gap in learning needs, or know of a tool or resource that is not currently available through our website?

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PVN is a community of patients, families and caregivers working together with health care partners to improve BC’s health care system. PVN connects patient partners with health care partners who are seeking to engage the patient voice in their efforts to improve quality of care.

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"We are all cultural beings": My Experience at the Canadian Centre for Diversity and Inclusion UnConference
My name is Bev Pomeroy, I prefer to use they/them pronouns. I had the privilege of attending the Canadian Centre for Diversity and Inclusion Unconference this past May. The Canadian Centre for Diversity and Inclusion (CCDI) is a made-in-Canada solution designed to help employers, diversity and inclusion/human rights/equity and...
Continue reading...

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Patient Voices Network | Become a PVN Member Today!

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"We are all cultural beings": My Experience at the Canadian Centre for Diversity and Inclusion UnConference My name is Bev Pomeroy, I prefer to use they/them pronouns. I had the privilege of attending the Canadian Centre for Diversity and Inclusion Unconference this past May.

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Our Guide to Authentic Patient Engagement contains a number of resources to support your team wherever you are on your patient engagement journey.

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Culturally Safe Engagement: What Matters to Indigenous Patient Partners

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Culturally Safe Engagement: What Matters to Indigenous Patient Partners

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This guide to creating culturally safe engagements was created from the voices of Indigenous (First Nations, Métis and Inuit) patient partners. We hosted an event centred around “What Matters to You in Indigenous Culturally Safe Patient Engagements?”, where we heard from Indigenous patient partners about what makes them feel comfortable and safe during engagements.