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Volume 2 Issue 5
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ssues and
P
eople
she says. “Unfortunately, there’s not a lot of research on
patient safety incidents that occur in dental settings. There
is some information on wrong-site extractions, or needle
sticks, but nothing necessarily about documentation errors
in patient charts or contraindications of medications.”
Learning fromMedicine
As part of a CFHSG initiative, the Dental Services are
embarking on an ambitious project that aims to adapt
patient safety measures used in medicine to the dental
setting. “As a military organization, a great benefit is our
system-wide approach,” says Lieutenant-Colonel Joy. “We
have 42 dental clinics that function like individual dental
practices but are integrated with primary medical care as
part of the overall organizational structure for the CFHSG.
With this kind of system, we can implement different
processes and measure their effectiveness; we can promote
best practices and advance dentistry not only for our own
patients and but also as a test bed for the rest of the country.”
Integrating medicine and dentistry in the CFHSG’s approach
to patient safety also supports the overall health of patients.
“Within our organization, we have the ability to make
connections between the family physician and the family
dentist,” says Ms. Ranganathan. “And if we can establish that
as being a best practice, it could improve the integration of
oral care into an individual’s overall health care.”
Learning from the Air Force
Drawing parallels between safety in dentistry and in aviation
can be instructive: both share a team environment, a
systematic approach to processes, and benefit from crew
(team) resource management. By adapting the processes and
reporting framework used in the Royal Canadian Air Force
(RCAF) Flight Safety program to a health care environment,
CFHSG hopes to foster even safer, more reliable care. “We
have the benefit of having the RCAF in our backyard. Their
flight safety program is very well established and respected,
says Ms. Ranganathan. “So we’ve been able to take best
practices from their flight safety program and are applying
them to health care.”
To illustrate how flight safety principles apply to health
care, Lieutenant-Colonel Joy cites the use of patient safety
officers at every medical and dental clinic across the CFHSG,
mirroring the use of unit-level flight safety officers, and the
implementation of an incident reporting system informed
by the RCAF system. CFHSG also hopes to examine and learn
from RCAF’s highly successful, deep-rooted culture of safety.
Changing Attitudes
It’s the intangible aspects of a patient safety program—those
that help define a workplace culture—that are perhaps most
difficult to establish. Developing a culture of safety involves
encouraging openness to reporting mistakes, a move
that many clinicians may be unwilling to make because of
perceived negative implications. But shifting the emphasis
away from blame is a key part of ensuring a strong culture of
patient safety, says Ms. Ranganathan. “Very rarely is an error
deliberate or the result of incompetence. Usually, an error
occurs because of a system failure or process breakdown.
We need to help patients feel confident that we’re going
to do something about preventable errors. It’s really about
a cultural shift, at arriving at the understanding that what
makes me a better clinician is that I’m doing something
about my mistake.”
To help further enhance the culture of patient safety within
the military health services, the CFHSG is partnering with
the Canadian Patient Safety Institute (CPSI) to implement a
patient safety education program across the organization.
The goal of the program is to train enough patient safety
trainers to sustain a peer-to-peer system of education for
all levels of health care workers, based on a curriculum
that develops attitudes, knowledge, specific skills, and
behaviours around patient safety. For this work, the CFHSG
was awarded CPSI’s Innovation in Patient Safety Education
Award for 2014.
Although the education program is still in its infancy, it has
the potential to change how patient safety is considered
and managed in military dental clinics. What the military
Dental Services learns from this work could inform
discussions about patient safety in Canadian dentistry and
health care, in general. Ultimately, it has the potential to
improve patient care.
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