Safe medical care research

In over a century of providing advice and assistance to physicians, the CMPA has accumulated the largest collection of physician-related medical-legal data in the world. Using innovative quantitative and qualitative analysis techniques, the CMPA is able to gain insights and identify gaps that affect safe care.

In 2016, the CMPA established an evidence synthesis team comprised of researchers, physicians, nurses, and statisticians. The group investigates the current state of scientific evidence to gain a fulsome understanding of the patient safety landscape and to help shape the CMPA’s work in safe medical care.

In the past, we have shared insights with members through risk management information and education. Today, we are also sharing our findings by publishing in peer-reviewed journals.

We look forward to making our research available to physicians and researchers working in quality improvement, patient safety and medical education to empower safe medical care.

Published articles

  • A Quality Indicator Framework for High-Risk Areas in Obstetrical Care
    This study describes the development of a set of quality improvement indicators for areas of practice associated with increased medical-legal risk in order to support measurable improvements in obstetrical practice. It illustrates the importance of balancing measures when creating quality metrics, as well as providing practical quality indicators for quality improvement teams and researchers to engage in improvements in obstetrics quality of care.
    Calder LA, Bowman CL, Yang Q, Gondocz T, Young C, Zhang C, MacIntyre A, Darling R, O’Neill JP, Roye C, Lefebvre, G. 2019. A quality indicator framework for high-risk areas in obstetrical care. Unpublished manuscript, Canadian Medical Protective Association.

  • Surgical Fires and Burns: A 5-Year Analysis of Medico-legal Cases
    This paper provides a retrospective descriptive analysis of the contributing factors in medico-legal cases involving surgical fires and burns in Canada over a 5-year period. This study highlights a need for improved surgical safety interventions to address surgical fires and burns.
    Calder L, Héroux D, Bernard C, Liu R, Gilchrist A, Neilson HK, Gilchrist AD, Fish J. Surgical fires and burns: a 5-year analysis of medico-legal cases. J Burn Care Res. 2019:1-7. [epub ahead of print]

  • Recommendations from the National Panel on Quality Improvement in Obstetrics
    This paper describes the recommendations of a national panel on quality improvement in obstetrics to identify priorities for action among five areas of greatest medico-legal risk. Using previously conducted medico-legal data analyses and a systematic literature review, the panel reviewed existing data and developed recommendations for areas of focus in quality improvement in five obstetrical high-risk areas. The panel recommended clarification of definitions in some areas, identified needs for data collection and standardization of practices in others. The most promising interventions to improve care in the five areas were grouped into: standardized processes (such as protocols and communication tools), checklists, audit and feedback, mentoring and coaching, inter-professional communication, simulation and training, and shared decision making guides. This national panel of experts created 18 action-oriented recommendations focused on quality improvement to reduce medico-legal risk and improve the safety of care for Canadian mothers and babies.
    Lefebvre G, Calder LA, De Gorter R, Bowman CL, Bell D, Bow M, et al. Recommendations from a National Panel on Quality Improvement in Obstetrics. J Obstet Gynaecol Canada [Internet]. 2019 May [cited 2019 May 9]; 41(5):653–9. Available from:

  • Using medicolegal data to support safe medical care: A contributing factor coding framework (article)
    This methodological paper discusses a new patient safety-informed framework developed by the CMPA, which acknowledges the effects of team, organizational, and system factors, in addition to physician care. This new approach revolutionizes the way the CMPA codes its medical-legal data, and improves understanding of the many factors that contribute to patient safety events.
    McCleery A, Devenny K, Ogilby C, Dunn C, Steen A, Whyte E, et al. Using medicolegal data to support safe medical care: a contributing factor coding framework. J Healthc Risk Manag [Internet]. 2018 Aug 3 [cited 2018 Nov 19]; Available from:

  • Improved hospital safety performance and reduced medico-legal risk: an ecological study using two Canadian databases (article)
    This paper analyzes two Canadian databases, the CMPA and the Discharge Abstract Database, to determine if there was a relationship between in-hospital patient safety events and medico-legal cases involving physicians in Canada. This study is novel in that there are very few like it based on Canadian data and it shows the practical use for medico-legal and patient safety data, which can be used to improve patient safety and quality of care.
    Yang Q, Zhang C, Hines K, Calder LA. Improved hospital safety performance and reduced medicolegal risk: an ecological study using 2 Canadian databases. CMAJ Open [Internet]. 2018 Nov 19 [cited 2018 Nov 23];6(4):E561–6. Available from: