Patient safety is so much more than physical safety in hospital settings

Nov 1, 2023

PAN kicked off Canadian Patient Safety Week 2023 with a conversation on October 23 where PAN Community members looked at the changing views of patient safety. Clearly our Community of patient/caregiver partners has thought deeply about many aspects of safety. At a high level, we discussed the need to expand the notion of patient safety to include psychological and cultural safety.  It was also clear that the healthcare system itself contributes to safety … or lack of safety. Here are the reflections that were shared.

The one-hour discussion surfaced three themes:

  1. Access
  2. Accountability
  3. Listening

Access – different aspects of access are key elements of patient safety.

Firstly, timeliness. People are being harmed because of long wait times. Illnesses are not diagnosed until it’s too late. There’s preventable suffering if surgeries can happen when they should. One participant said they want “proper healthcare in a timely fashion.”

Secondly, services.  The big city centres are where many, if not most, services are located. Little thought is given to people who live in rural and remote areas. One participant brought up services like chronic pain injections that are only available in major centres. Add to that the frequency of the visits and it is almost impossible for many patients especially those without access to a vehicle or money or transportation support.

Thirdly, data. Patients need access to their data. This could empower patients to get more involved in their care. No one is more invested in a patient’s health than the patient themselves. There have been incidences of vital information that has been missed by healthcare professionals leading to harm. Patients need to be able to review their records and have a way to correct errors of fact.

Accountability provoked some new thoughts about safety.

Who is held responsible for not improving our healthcare system at the regional and provincial levels? We need to start holding people accountable to the promises they make as well as for where funds are going.  There needs to be people at all levels that hear our concerns and provide a kind of “moral safety.”

People move around within the healthcare system and sometimes cross jurisdictions. Harms can come from their data not flowing along with them. Harm can come from transitioning across sites of care but complaints mechanisms are usually tied to single organizations like hospitals. Where is the system level accountability to the patient in those circumstances?

Listening has many aspects of safety.

Almost every participant spoke about listening as an element of patient safety. While there was a recognition that staffing shortages and time pressures challenged providers’ abilities to listen, be compassionate and be empathetic, this was still considered a key area of safety concerns. Systemically, providers need to be supported in taking the time needed to listen to their patients.  Lack of this support contributes to unsafe care.

There’s a lack of listening and empathy especially when patients don’t fit the mold with regards to their health concerns. Patients and caregivers have expertise in their illnesses and need to be listened to so they can collaborate with providers in their care. However, there is a sense that the culture of healthcare lacks respect for patients as partners in their own care.

Lack of empathy can be a particularly acute issue if the patient has been a victim of violence in the past impacting their reactions and ability to trust. This can result in a lack of psychological safety.

Bias and outright discrimination based on race, culture, gender, age, mental health and even physical health conditions can result in unsafe or withheld care for too many. For some, hidden diseases like fibromyalgia or mental illness resulted in patients feeling like their concerns weren’t valid. One participant mentioned she would hide her illness when bringing up unrelated health concerns because she was afraid healthcare providers would dismiss them if they knew about her other illness. Older people, especially those starting in on dementia are often dismissed and not listened to.  One person referred to this as “gaslighting”.

The lack of understanding, acceptance and respect for groups, especially First Nations and Métis, continues to be prevalent. Many cultures have different approaches that need to be understood and appreciated for people to trust in the care they receive.  Too many people experience a lack of cultural safety and deep harms including death can be a result.

The discussion just touched the tip of the iceberg. We will carry it on within the PAN Community and within our collaborations as patient/caregiver partners.  We can work together to make progress towards a safer environment for everyone.


With many thanks to contributions made by PAN members Wade Bittle, Ramona Bonwick, Diana Ermel, Trudy Flynn, Sandra Holdsworth, Elke Hutton, Alies Maybee, Anna Maynard, Ron Reddam, Donna Rubenstein, Candace Skrapek, Calvin Young

PAN Members Community Guidelines

We want everyone to feel welcome on our PAN community site, so we’ve created these guidelines to foster the community we would like to see. By joining and participating in our Community, you agree that you have read and will follow these guidelines.

Within the PAN Community site and in our dealings with each other through other PAN initiatives:

  1. Be respectful. We all have a shared goal of making healthcare better for Canadians. The PAN Community may include people you work with or may meet in future. As members of PAN, we demonstrate respect in our communication, sharing and crediting of resources/knowledge and  in our interactions with each other and stakeholders from outside the PAN.


  1. Focus on a positive and collaborative approach.  Let’s work together to build strong relationships so we can achieve great things. Diversity of thought and sharing of perspectives is healthy – we won’t all agree on everything, but we want to keep an open mind to consider new ideas and change.


  1. Do not discriminate or engage in harmful activity. We value different ideas and opinions but there is no place for any activity that could hurt someone, whether it’s physical, emotional, mental or digital. Racism, hateful language, or discrimination of any kind is not acceptable. Don’t post anything you wouldn’t want everyone in the world to know about or that you wouldn’t want anyone to know that it came from you.


  1. Use your true identity. We made this community site private so that we can feel free to be ourselves. Each member is vetted by our team to ensure people are here for the right reasons. Communicating with each other is based on trust.

To ensure the PAN community remains a safe place for all members, we ask you that you contact if you encounter a situation where guidelines may have been breached. PAN reserves the right to suspend or terminate membership in the Community for anyone who violates these guidelines.


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Directives de la communauté des membres du PAN

Nous voulons que tout le monde se sente bienvenu sur notre site Web communautaire de PAN. Nous avons donc créé ces directives pour aider au développement de la communauté que nous aimerions voir. En rejoignant et en participant à notre communauté, vous acceptez de lire et de suivre ces directives.

Sur le site de Web de la communauté de PAN et dans nos relations mutuelles dans le cadre d'autres initiatives de PAN :

  1. Soyez respectueux. Nous partageons tous l'objectif d'améliorer les soins de santé pour les Canadiens. La communautéde PAN peut inclure des personnes avec lesquelles vous travaillez ou que vous pourriez rencontrer à l'avenir. En tant que membres de PAN, nous faisons preuve de respect dans notre communication, le partage et l'attribution de ressources/connaissances et dans nos interactions les uns avec les autres et avec les parties prenantes extérieures de
  2. Se concentrersur une approche positive et collaborative.  Travaillons ensemble pour construire des relations solides afin de réaliser de grandes choses. La diversité de pensée et le partage des perspectives sont sains - nous ne serons pas tous d'accord sur tout, mais nous voulons garder l'esprit ouvert pour envisager de nouvelles idées et des changements.
  3. Ne faites pas de discrimination et neparticipez pas à des activités nuisibles. Nous apprécions les idées et les opinions différentes, mais il n'y a pas de place pour les commentaires susceptibles de blesser quelqu'un, que ce soit physiquement, émotionnellement, mentalement ou numériquement. Le racisme, les propos haineux ou la discrimination sous quelque forme que ce soit ne sont pas acceptables. Ne publiez rien que vous ne voudriez pas que tout le monde sache ou dont vous ne voudriez pas que l'on sache qu'il vient de vous.
  4. Utilisez votre véritable identité. Nous avons rendu ce site Web communautaire privé afin que nous puissions nous sentir libres d'être nous-mêmes. Chaque membre est accepté manuellementpar notre équipe pour s'assurer qu'il est là pour les bonnes raisons. La communication entre nous est basée sur la confiance.

Pour s'assurer que la communauté de PAN reste un endroit sûr pour tous les membres, nous vous demandons de contacter  si vous rencontrez une situation où les directives ont été violées. PAN se réserve le droit de suspendre ou de résilier l'adhésion à la communauté de toute personne qui enfreint ces directives.

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