Protection of quality improvement information
The CMPA has published on the importance of protecting information collected during quality improvement reviews. In its position paper, Reporting and responding to adverse events: A medical liability perspective the CMPA recommends balancing the protected nature of the review with the public's right to know how healthcare safety can be improved. The Association advocates for maintaining legislative protection for quality improvement (QI) documentation as any erosion to current protection could be detrimental to patient safety efforts. Without legislative protection, healthcare providers could be discouraged from becoming fully engaged in a meaningful QI review and examination of the facts and circumstances of an adverse event. The Association also recognizes that the same protection of information is not appropriate in accountability reviews, which look at the conduct or performance of an individual care provider. It is important that these reviews are conducted in a manner that is fair to all involved parties, and respects relevant policies, bylaws, or legislation.
While all Canadian provinces and territories have some legislated protection for QI information, the degree of statutory protection varies. Recent changes to some provincial and territorial legislation, inquiry recommendations, and organizational bylaws and regulations are threatening to erode current QI protections and could ultimately undermine patient safety.
The maintenance of QI protections is considered one of the cornerstones of a just culture of safety. However, the vital role that QI protections play in benefiting and advancing patient safety efforts may not be well understood by decision makers. Public and media pressure have led some regions to advocate for the full disclosure of information collected during QI reviews, in the hope this will benefit safety efforts, whereas the opposite is more likely to be true.
In a protected QI review process, physicians and healthcare providers are encouraged to speak openly and honestly about the details of an adverse event. The goal is to learn from the event and therefore prevent future occurrences, rather than seeking blame. Physicians and other healthcare providers are less likely to come forward and speak frankly in an unprotected environment.
In the analysis of an adverse event, patients should be informed of any new facts that are identified. They should also be informed of the conclusions, but the opinions leading to those conclusions should remain protected. The review may confirm that the clinical outcome resulted from the patient's underlying medical condition or the risks inherent in an investigation or treatment. Conversely, the review may identify system vulnerabilities or failures. Speculations should not be provided and blaming should be avoided. An apology may be warranted.
The CMPA believes it is important to strike a balance between the protected nature of the QI learning environment and the public's right to know about the outcomes of an adverse event. To achieve this balance, and where permitted by legislation, the CMPA believes all recommendations from QI reviews that do not relate to individual performance should be released, regardless of whether the recommendations will be implemented or not.
The CMPA recommends the following actions, recognizing the importance of QI protections in improving the safety of medical care:
- Maintain current provincial legislation protecting information collected in the QI review process. Any erosion to current protections would discourage healthcare providers from fully engaging in a meaningful examination of the facts and circumstances of an adverse event. Loss of QI protections would seriously undermine efforts to improve patient and system safety.
- Implement legislation that mandates the reporting of adverse events, clearly specifying the conditions under which reporting will take place. Ensure that a standardized approach to adverse event reporting is created.
- Balance the public's right to know about the outcomes of an adverse event with the protected nature of the learning environment. Publicly releasing all recommendations for improvements from QI reviews, not just those that will be implemented, promotes transparency and public accountability, while protecting individual participants from medical liability risk. .
- Implement policies that require the sharing of QI review recommendations and identify recommendations to be implemented.
- Support learning from properly constructed and appropriately conducted QI review and encourage healthcare providers to participate. Maintain an information firewall between QI and accountability reviews.
The CMPA has published the following papers on QI: