Duties and responsibilities

Expectations of physicians in practice

The safety performer: Putting safe care at the forefront

Originally published May 2015

Physicians strive to provide quality care for their patients, but how can they do so safely?

Much progress has been made in recent years to understand the attributes and competencies of physicians who put safety at the forefront when caring for patients. Medical schools, medical associations, regulatory authorities (Colleges), and the CMPA, among other organizations, are working to nurture these qualities and help to advance healthcare safety.

Are you a safety performer?

Patient safety incidents can occur even with rigorous safety protocols in place. But the likelihood that safety incidents will occur — along with the potential for harm to patients and medico-legal difficulties for physicians — is reduced when safety is top of mind. “Safe performers” successfully internalize safety practices, and in doing so, become role models for others.

Physicians can contribute to a safety workplace culture in their roles as care providers, leaders, learners, and peers. At an organizational level, this means supporting a culture where everyone feels comfortable to speak up when they have concerns about safety. In a team setting, physicians support healthcare safety by working collaboratively with other healthcare providers, clarifying roles and expectations, avoiding intimidating behaviour, communicating effectively, and fostering positive interpersonal relationships.

Doctors can also follow and promote various practices to anticipate, recognize, and manage situations that place patients at increased risk (e.g. diligent use of safety checklists). Safe performers practise critical thinking and situational awareness, and recognize distortions in thinking which may affect their decision-making. They look after themselves by staying healthy, avoiding fatigue, and managing stress. Such physicians seek to continuously improve their knowledge skills by participating in professional development activities. And lastly, they recognize when a patient safety incident or a near miss has occurred and respond appropriately. They disclose the incident to patients in an appropriate manner, learn from the experience to improve their own performance, and support necessary system changes to prevent recurrences.

Situational awareness

A person’s perception and understanding of the dynamic information in their environment. It is about keeping track of what is going on around you, and anticipating what might need to be done.

Safe approaches to patient care

The ways in which physicians work with and care for their patients may also contribute to safety. For example, physicians may opt for specific approaches to help deepen patients’ involvement in their care, including actively listening to patients and families, responding to patients’ concerns, providing information in the manner patients prefer to receive it, and carefully considering patients’ level of health literacy. Helping patients understand the implications of the care plan and engaging them in the decision-making process strengthens the exchange and partnership between physicians and patients. This may also enhance the safety of care.

As well, physicians should be attuned to cultural influences which may impact care. A lack of cultural competence can affect patient safety and impact overall health outcomes.1 To deliver culturally safe care, physicians must develop a relationship of trust with patients and families, one that recognizes and respects individual differences.

Cultural competence

The attitudes, knowledge, and skills needed to effectively provide care for patients of diverse backgrounds. It is about demonstrating you are interested in cultural issues that affect a patient’s health and to reasonably accommodate patients’ values without judgment.

Learning, improving, growing

Learning and incorporating safety competencies into practice does not necessarily come automatically. These competencies must be encouraged and nurtured.

Organizations such as the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC) are increasingly emphasizing medical education that focuses on patient needs and the competencies required by physicians to meet those needs. The competency-based approach shifts the emphasis away from the traditional time-based model of education (i.e. number of hours spent in residency programs) and places it on assessing performance and self-auditing of quality.

Later in 2015, the RCPSC’s CanMEDS framework will incorporate milestones for each of the CanMEDS roles (i.e. medical expert, communicator, collaborator, leader, health advocate, scholar, and professional). The milestones will reflect the abilities expected of physicians at defined stages of development and provide clarity for both learners and evaluators as to when a learner is ready to move to the next stage of training. In future, milestones will be integrated from the beginning to the end of a physician’s practice.

Physicians may also be familiar with the safety competencies identified by the Canadian Patient Safety Institute. These competencies identify the knowledge, skills, and attitudes of safe performers in such areas as contributing to a culture of patient safety, working in teams, communicating, managing safety risks, human and environmental factors, and disclosing patient safety incidents.2

Leveraging CMPA educational resources to improve practice

The CMPA, too, has renewed its educational programming to better focus on safety at both the individual practitioner level and system level. These efforts are being incorporated into the Association’s current offerings — e-learning and education articles. Moreover, the Association’s 2015-2017 symposia and regional conferences focus on practical tips for safe care including diagnosis, prescribing, effective communication between healthcare providers, and pitfalls to avoid when using electronic communication and electronic medical records. Indeed, CMPA members know that the best protection for physicians and their patients is to prevent patient harm from occurring in the first place.

Online resources such as the CMPA Good Practices Guide are increasingly important learning tools. The guide identifies ways of thinking and acting that the CMPA believes will help physicians provide safe care. It focuses on many of the non-clinical aspects of medical practice that contribute to positive patient outcomes, including communication, teamwork, diagnostic processes, cognitive and environmental factors, and cultural and boundary issues.

Continuing education is an important part of becoming a safety performer, but is not a panacea. Attending education sessions and earning CME credits help individual physicians remain up to date, but it may not be enough. Physicians need to reflect on their practice and seek to implement what they learn to improve care. Education needs to be interactive and ongoing, and will likely increasingly take place at the point of care with clinical decision support tools — in other words, it will be integrated into everyday practice.



  1. The Hospital for Sick Children, “Introduction to clinical cultural competence,” Cultural competence E-learning modules series, 2013 (slide 10)
  2. Canadian Patient Safety Institute, The Safety Competencies, August 2009. Accessed on November 28, 2014 from: http://www.patientsafetyinstitute.ca/English/toolsResources/safetyCompetencies/Documents/Safety%20Competencies.pdf

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.