activating knowledge for patient safety practices: a canadian … · 2013. 12. 13. · activating...

Original Article

Activating Knowledge for Patient SafetyPractices: A Canadian Academic-PolicyPartnership

Margaret B. Harrison, RN, PhD, Wendy Nicklin, RN, MSc(A), Marie Owen, RN, MScN, Christina Godfrey, RN, MSc,Janice McVeety, RN, MHA, Val Angus, BA

ABSTRACTBackground: Over the past decade, the need for healthcare delivery systems to identify and address

patient safety issues has been propelled to the forefront. A Canadian survey, for example, demonstratedpatient safety to be a major concern of frontline nurses (Nicklin & McVeety 2002). Three crucial patientsafety elements, current knowledge, resources, and context of care have been identified by the World HealthOrganization (WHO 2009). To develop strategies to respond to the scope and mandate of the WHOreport within the Canadian context, a pan-Canadian academic-policy partnership has been established.

Approach: This newly formed Pan-Canadian Partnership, the Queen’s Joanna Briggs Collaborationfor Patient Safety (referred throughout as “QJBC” or “the Partnership”), includes the Queen’s UniversitySchool of Nursing, Accreditation Canada, the Canadian Patient Safety Institute (CPSI), the CanadianInstitutes of Health Research, and is supported by an active and committed advisory council representingover 10 national organizations representing all sectors of the health continuum, including patients/familiesadvocacy groups, professional associations, and other bodies. This unique partnership is designed toprovide timely, focused support from academia to the front line of patient safety.

QJBC has adopted an “integrated knowledge translation” approach to identify and respond to patientsafety priorities and to ensure active engagement with stakeholders in producing and using availableknowledge. Synthesis of evidence and guideline adaptation methodologies are employed to access quanti-tative and qualitative evidence relevant to pertinent patient safety questions and subsequently, to respondto issues of feasibility, meaningfulness, appropriateness/acceptability, and effectiveness.

Summary: This paper describes the conceptual grounding of the Partnership, its proposed methods,and its plan for action. It is hoped that our journey may provide some guidance to others as they developpatient safety models within their own arenas.

KEYWORDS knowledge to action, knowledge translation, evidence-informed practice, knowledge synthesis,systematic reviews, patient safety

Margaret B. Harrison, Professor, School of Nursing, Queen’s University, Kingston, Ontario, Canada; Wendy Nicklin, President and Chief Executive Officer, Accreditation Canada,Ottawa, Ontario, Canada; Marie Owen, Medication Reconciliation Lead—Canada, Canadian Patient Safety Institute, Edmonton, Alberta, Canada; Christina Godfrey, DeputyDirector/Methodologist, Queen’s Joanna Briggs Collaboration, Queen’s University, Kingston, Ontario, Canada; Janice McVeety, Patient Safety Officer, Queen’s Joanna BriggsCollaboration, Queen’s University, Kingston, Ontario, Canada; Val Angus, Business Officer, Queen’s Joanna Briggs Collaboration, Queen’s University, Kingston, Ontario, Canada.

Authors listed represent the Queen’s Joanna Briggs Collaboration (QJBC) Team. The QJBC team is comprised of academic and clinically-based faculty, library scientists,methodologists and core research staff located at the Queen’s University School of Nursing, as follows: M.B. Harrison (Principal Investigator), J. Medves, E. VanDenKerkhof,M. Lamb, C. Baker, D. Buchanan, S. Maranda, D. Edge, L. Keeping-Burke, S. Laschinger, L. Duhn, & L. Gedcke-Kerr (Co-investigators), and C. Pulling, J. Peterson, & J.DeWolfe (collaborators). QJBC Research Staff: Dr. C. Godfrey (Methodologist), V. Donaldson (Project Officer), J. McVeety (Patient Safety Officer), V. Angus (Business Officer),A. Ross-White (Library Scientist) and K. Dean (Research Assistant).

The Queen’s Joanna Briggs Collaboration is the first Canadian Center of the Joanna Briggs Institute. QJBC was established in 2004 as an academic-practice partnership withthe generous support of Ontario Ministry of Health and Long-term Care, Queen’s University, JBI and the South Eastern Ontario Health Sciences Centre. In November 2009,QJBC received additional support through a 5-year operating grant from the Canadian Institutes of Health Research, Knowledge Synthesis and Exchange Program to establishan academic-policy partnership with national partners, the Canadian Patient Safety Institute and Accreditation Canada.

Address correspondence to Dr. M.B. Harrison, School of Nursing, Queen’s University, 78 Barrie Street, Kingston ONT K7L 3N6; [email protected]

Accepted 7 April 2011Copyright ©2011 Sigma Theta Tau Internationaldoi: 10.1111/j.1741-6787.2011.00231.x

Worldviews on Evidence-Based Nursing �First Quarter 2012 49

Academic-Policy Partnership for Patient Safety

BACKGROUND

Over the past decade, several important reports havepropelled patient safety to the forefront for health-

care delivery in North America. These include the land-mark US report, To Err is Human: Building a Safer HealthSystem (Kohn et al. 2000), the Canadian report, Building ASafer System: A National Integrated Strategy for ImprovingPatient Safety in Canadian Health Care (National SteeringCommittee on Patient Safety 2002) and The Canadian Ad-verse Events Study: The Incidence of Adverse Events amongHospital Patients in Canada (Baker et al. 2004). Baker et al.(2004) cite the overall incidence rate of adverse events(AE) to be 7.5% suggesting that, “of the almost 2.5 millionannual hospital admissions in Canada similar to the typestudied, about 185,000 are associated with an AE and closeto 70,000 of these are potentially preventable” (p. 1678).

The Agency for Healthcare Research and Quality(AHRQ) consensus report was one of the first efforts toamalgamate patient safety research by defining a list of“best practices” ranked according to strengths of evidence(Shojania et al. 2001). However, at that time available stud-ies for “best practice” were in large part limited to areasof high acute care medical risk. While addressing medicaladverse events in hospital acute care is important giventhe diversity of the Canadian landscape, the scope mustbe broadened to increase emphasis on prevention of com-mon, often devastating events in all areas of healthcaredelivery, including long-term care, home care, and ruraland remote settings. To date very little research focuses onpatient safety in settings outside of hospitals, a disturbingaspect given the current trend to transfer care previouslydelivered in hospitals to ambulatory, home, and residen-tial care. In a Canada-wide survey, Nicklin and McVeety(2002) demonstrated that patient safety is a major concernof frontline nurses. Because nursing teams provide directcare across the continuum of care settings they possesstacit knowledge of all aspects of the care context and are ina unique position to assess safety and risk. One of QJBC’smandates therefore is to synthesize all available evidencefor use by providers and patients in rural and remote care.

Advancing Evidence-Informed Practicesfor Patient SafetyIn 2004, WHO launched the World Alliance for PatientSafety to facilitate the development of patient safety policyand practice. They define patient safety as “. . .the reduc-tion of risk of unnecessary harm associated with health-care to an acceptable minimum. An acceptable minimumrefers to the collective notions of given current knowl-edge, resources available and the context in which carewas delivered weighed against the risk of non-treatment or

other treatment” (WHO 2009, p. 15). The World Alliance’svision identified three important patient safety elements(current knowledge, resources, and context) required to en-sure patient safety issues are addressed, giving rise to twosignificant questions: (1) How much do we know about thestate of current knowledge for implementing safe patientcare? and (2) What type of research evidence comprisescurrent knowledge in patient safety?

Although patient safety is a concern in virtually everyhealth sector, it is still a relatively new focus on the re-search frontier. Leape et al. (2002) argue that reasonablejudgments have to be made on current knowledge, that is,until safety multi-interventions are more fully evaluatedwith appropriate experimental research, focus for synthe-sis must rely on the best available evidence, for example,large cohort studies or program evaluations.

Resource availability issues are also important elementsto consider when implementing patient safety initiatives.For example, the availability and use of beds lower to thefloor may be required for falls prevention, and lack of mayunderpin a sequelae of events that contribute to an adverseevent.

Understanding of contextual issues assists in imple-menting high-level evidence about effectiveness of partic-ular strategies, whereas understanding patient experiencethrough a synthesis of qualitative studies may provide afoundation to design more appropriate and acceptable in-terventions for patients/families. Leape et al. (2002) notedthat patient safety interventions cannot be separated fromthe context of the organization in which care is deliv-ered. The context-specific focus with patient safety evi-dence highlights the importance of taking a broader viewof what constitutes evidence. For example, there are nu-merous guidelines and tools developed to address the mul-tisector challenge of pressure ulcer prevention, but thesehave largely been developed for use in acute care by reg-istered nurses. The question becomes how to use this ev-idence in the context of community and long-term caresettings by unregulated workers and family members do-ing assessments.

THE CANADIAN INITIATIVE

Building Support from the Academy to the FieldIn 2004, the Queen’s Joanna Briggs Collaboration (QJBC)was first established as the first North American collab-orating center of the Joanna Briggs Institute. QJBC wasconceived as a regional academic-practice partnership withQueen’s University School of Nursing and the South East-ern Ontario Health Sciences Centre, supported through agrant from the Ontario Ministry of Health and Long-TermCare. Its mandate was to develop an academic-practice

50 First Quarter 2012 �Worldviews on Evidence-Based Nursing


model driven by local practice policies to improve health-care delivery in our region through the synthesis and im-plementation of best available evidence (Harrison et al.2004–2008). With the support and input from our prac-tice partners, QJBC evolved into an active and productiveknowledge translation model and provided a firm foun-dation on which to further develop this center beyondour regional scope into a pan-Canadian academic-policyeffort.

In November 2009, QJBC expanded to establish a pan-Canadian patient safety academic-policy partnership, withthe support and encouragement of the Canadian Institutesof Health Research (CIHR) Knowledge Syntheses and Ex-change. CIHR granted the university and QJBC 5-yearfunding (Harrison et al. 2009–2014) to formalize a na-tional patient safety academic-policy partnership with itspolicy partners, Accreditation Canada, and the CPSI andCIHR.

Accreditation Canada (www.accreditation.ca) is a not-for-profit, independent organization that provides Cana-dian health organizations with an external peer reviewprocess to assess the quality of their services in accor-dance with nationally established standards of excellence,such as risk management, infection prevention and con-trol, and medication management. Accreditation Canadaprovides services in more than 30 healthcare sectors, in-cluding acute care, home care, rehabilitation, commu-nity and public health, hospice palliative care, labs andblood banks, and diagnostic imaging. Their clients includeRegional Health Authorities, hospitals, and community-based programs and services, from both private and pub-lic sectors. Patient safety is an integral component of theevidence-based accreditation programs.

CPSI (www.patientsafetyinstitute.ca) was created in De-cember 2003 to provide national leadership to build andadvance a safer healthcare system in Canada. CPSI facil-itates patient safety initiatives through collaboration be-tween provincial governments and stakeholders, includingpatients. CPSI focuses on four key areas: (1) education, (2)research, (3) interventions and programs, and (4) tools andresources.

QJBC provides cohesive leadership as an academic-policy partnership to improve both access to and uptakeof evidence on patient safety. Specifically this includes thesynthesis of evidence based priority topics identified bypractice and policy partners, and the adaptation of alreadysynthesized evidence from one context to another (e.g.,adapting a guideline developed for acute care for use incommunity care). QJBC’s goals will be achieved throughthree patient safety focused strategies designed to (1) buildinfrastructure, (2) facilitate evidence production (synthe-ses and adaptation), and (3) establish networks. Initial

milestones to firmly establish our partnership includedthe development of an advisory council to establish andoversee QJBC initiatives. With our policy partners and thesupport of our governance body (advisory council), westrive to build a sustainable, vibrant community of prac-tice focused on evidence generation and evidence use forpatient safety that includes a focus across the continuumof care.

GUIDING FRAMEWORKS

The Knowledge to Action (KTA) framework (Graham et al.2006) underpins QJBC and is instrumental to its successby outlining a planned action framework for knowledgegeneration and the steps in the active phase of knowledgeuptake.

QJBC has the dual focus of knowledge generation andknowledge to action (highlighted in Figure 1). QJBC willgenerate knowledge and tailor it for use in practice throughsyntheses and systematic reviews of best available patientsafety evidence drawn from primary studies. Knowledgeproducts, such as adapted guidelines, will be developed.KTA activities include working collaboratively with ourpartners to establish priorities for evidence synthesis anddeveloping a network of stakeholders and a community ofpractice, to promote evidence use in patient safety.

The vision for QJBC integrates a planned-action ap-proach to knowledge use with the WHO conceptual frame-work. The WHO (2009), Conceptual Framework for theInternational Classification for Patient Safety, identifies 10high level classes, namely: Incident Type, Patient Out-comes, Patient Characteristics, Incident Characteristics,Contributing Factors/Hazards, Organizational Outcomes,Detection, Mitigating Factors, Ameliorating Actions, andActions Taken to Reduce Risk. As noted by the develop-ers, it aims to provide a comprehensive understanding ofthe domain of patient safety to represent continuous learn-ing and improvement. The emphasis is on identification ofrisk, prevention, detection, reduction of risk, incident re-covery, and system resilience which occur throughout andat any point within the conceptual framework.

Integrating the hierarchical subdivisions and flow of theWHO framework with the KTA approach provides QJBCwith a comprehensive model for activating patient safetyevidence. Over several substantive working sessions, theQJBC research group drafted a patient safety version ofthe action framework that places the patient safety ini-tiative into the KTA approach (Graham et al. 2006) andwill assist us in organizing our “products,” for example,systematic reviews and adapted guidelines, in a mannerfamiliar to the patient safety field. Figure 2 highlights thisintegrated framework that we refer to as the QJBC Model



Figure 1. QJBC focus within the knowledge to action framework.

for Activating Patient Safety evidence (QJBC-MAPS). Inthe new model, knowledge creation is generated throughknowledge inquiry, synthesis, and tools and products thatare specific to contributing factors/hazards within the pa-tient safety context. Analysis of these contributing fac-tors/hazards includes patient characteristics, incident type,and incident characteristics. Detection and mitigating fac-tors determine patient outcome and organizational out-comes, and lead to potential ameliorating actions. To-gether, detection and mitigating factors represent incidentrecovery (i.e., secondary prevention). According to WHO(2009), “Ameliorating actions are those actions taken orcircumstances altered to make better or compensate anyharm after an incident. Ameliorating actions apply to thepatient (clinical management of an injury, apologizing)and to the organization (staff debriefing, culture change,claims management” (p.13). As the knowledge related toreducing patient safety risk is identified, it is adapted tolocal context. For example, the actual application may bevery different in an acute care setting compared to homecare. As the knowledge is used by stakeholders, barriersto knowledge use are identified and it may be refined tobetter suit the situation in which it is needed.

The Integrated Knowledge Translation ApproachIn collaboration with CPSI and Accreditation Canada,QJBC is developing the infrastructure and strategic plan tocreate and/or synthesize evidence and then to disseminateit to interested communities. A fundamental element of theQJBC approach has been the amalgamation of field knowl-edge with external evidence using the science of synthesis(meta-analysis, metasynthesis) based on the Joanna BriggsInstitute’s model of evidence-based health care knownas FAME (feasibility, appropriateness/acceptability, mean-ingfulness, and effectiveness; Averis & Pearson 2003;Pearson 2004). Integrated knowledge translation engagesresearchers and research users throughout the researchprocess, from research question to methodological choices,and involves them in the actual conduct of the reviews orguideline adaptation projects (Graham & Tetroe 2007).Through its regional academic-practice partnership, QJBChas developed the methodological expertise and experi-ence in identifying research questions and findings, as wellas using and adapting evidence to particular contexts.

QJBC guideline adaptation procedures are drawn fromthe international ADAPTE approach (Harrison, Legare,Graham & Fervers, 2010) and, combined with the



Figure 2. QJBC model for activating patient safety evidence (QJBC-MAPS).

CAN-IMPLEMENT© methodology (Harrison & van denHoek, 2010) provides essential process issues and facili-tation elements. The CAN-IMPLEMENT is a resource tohelp providers and settings in the adaptation and use ofquality evidence-based guideline recommendations devel-oped for one context (e.g., hospital use by RNs) to beapplied to different context (e.g., home care by practicalnurses or support workers). This encompassing approachto evidence is critical to the actual uptake of new prac-tice knowledge since it builds on effectiveness research toinclude evidence relevant to the context.

Partnership stakeholders are instrumental in identify-ing pressing questions arising from their settings, therebycontributing to both knowledge generation and knowl-edge use phases. The Partnership, including stakeholders,design the methodological approach, conduct the reviews,and support the adaptation of external evidence to frontline

Canadian settings. As the academic partner, QJBC servesas scientific lead and facilitator, providing expertise for theproduction, and use evidence for patient safety.

As members of the Partnership, Accreditation Canadaand CPSI bring important yet distinct communities of prac-tice together through their respective stakeholder organi-zations. When they identify a gap or need in the fieldthat can be addressed through evidence synthesis or de-velopment of knowledge products (such as focused sys-tematic review or an adapted guideline) the academicwork by QJBC is initiated. Because potentially there maybe more questions raised than QJBC is able to address,Accreditation Canada and CPSI partners and their net-works will identify and set priority topic areas. For exam-ple, QJBC’s current work, in partnership with Canadianresearchers, targets patient safety and adverse events inthe home care setting. The university partner selects the



Figure 3. QJBC proposed project timeline.

appropriate scientific method and provides training andsupport. Together, the Partnership is establishing a policy-academic infrastructure that will be responsive to the com-munity of practice in patient safety.

During its first year, QJBC focused on establishingthe national consortium for the project. Initial site vis-its with Accreditation Canada and CPSI occurred and anadvisory council with national representation has takenplace (see Figure 3). Participants include AccreditationCanada, Canadian Patient Safety Institute, CIHR (nonvot-ing member), Patients for Patient Safety Canada, Queen’sUniversity School of Nursing, Royal College of Physiciansand Surgeons of Canada, Canadian Healthcare Association,Health Council of Canada, Canadian Home Care Associ-ation, Healthcare Insurance Reciprocal of Canada, Cana-dian Nurses Association, Canadian Medical Association,Canadian Pediatric Association, and the Community andHospital Infection Control Association Canada. The Ad-visory Council continues to refine our mission statementand is helping to establish priorities for the initiative; inparticular, it has emphasized the importance of includ-ing the patient perspective. The conceptual framework has

been developed by the project investigators over severalmonthly meetings; these meetings will continue on a bi-monthly basis as the initiative rolls out. To establish initialpriorities, QJBC undertook an environmental scan, a sum-mary of key patient safety organizations, and an initial scanof literature that determined the number of systematic re-views and studies in each priority area and incidence ofadverse events for each priority area. As well, an inven-tory of germinal patient safety literature and adverse eventstatistics have been collated, feedback obtained from part-ners on priority areas, and patient safety systematic reviewsand a guideline inventory initiated.

As QJBC progresses through its second year, there isincreased focus on the development of the Safety Re-source Engine and conducting several priority syntheses.A Web-based patient safety resource engine is being estab-lished that will be integrated into already available Web-based tools. The resource will facilitate the exchange ofexisting knowledge, tools, and resources in the area ofpatient safety. The engine will serve a “clearinghouse”function and include a registry of available syntheses, prac-tice guidelines, and clinical pathways with safety-related



recommendations. It will also function as a Web-basedtoolkit for finding, critically appraising, and synthesizingevidence, as well as tools for adapting already developedguidelines. In addition to the empirical evidentiary base,the resource engine is being designed to catalog frame-works, theories, and approaches used internationally (e.g.,quality assessment for guidelines, adapting guidelines fordifferent contexts). The key for QJBC is to enhance accessto patient safety related information while being mindfulof quality tools already available on the Web. To avoid du-plication, a directory of links to other networks of interestwill also be tabulated. For example, the new Patient SafetyCrosswalk (http://www.patientsafetycrosswalk.ca/) devel-oped by CPSI provides the latest updates across Canada onpatient safety interests, news, events, projects, and researchwill be included.

By year 3, in addition to evidence syntheses and guide-line adaptation, QJBC will collaborate with our partnersand other funding agencies to develop implementationstudies.

Evaluation of the Academic-Policy CollaborationThe overriding goal for QJBC is to improve the qualityand reliability of practice, and ultimately health outcomesby enabling a proactive use of best available evidence onpatient risk and safety in clinical and community settings.QJBC is a knowledge translation initiative and as such isevaluated differently than traditional research grants. Inthis case, CIHR does not expect us to simply measure bydeliverables or milestones, but rather looks for positiveimpact (anticipated and unanticipated) on the healthcarecommunity. CIHR allows knowledge translation initiativesthe flexibility to emerge and deviate if necessary from theoriginal proposal as the community’s needs evolve. Theprogression over time of the initiative is monitored byCIHR through annual reports submitted by the principalinvestigator. An influencing framework for our evaluationis the Lavis and colleagues’ multidomain framework forassessing country level efforts to link research to actionincluding general climate for research use, production ofrelevant and appropriately synthesized research for users,and the facilitating of “push and pull” efforts (Lavis et al.2006). The QJBC Advisory Council has developed a draftevaluation plan that is being further refined with inputfrom CIHR (see Figure 4).

Years 4 and 5 will see knowledge in patient safety beingput to action in terms of capacity building, education, train-ing, and the implementation of the knowledge translationplan. Partners will be assessed for needs regarding train-ing in evidence synthesis and use. For example, furthercapacity building will occur through initiatives with theCanadian Health Libraries Association, Joanna Briggs In-

stitute Comprehensive Systematic Review Training Work-shops, the Joanna Briggs Institute Colloquium, andCAN-IMPLEMENT© Training. Outreach will also involvecontinued work with the National Patient Safety Round Ta-ble events and the Canadian Healthcare Safety Symposia.Education will be supported through poster presentations,patient safety visiting scholars, and participation in nurs-ing research conferences.

Implications to Policy, Research and Practice,and EducationThe goal of knowledge translation in health care is to im-prove the quality of care and patient outcomes. The twofoldventure with the QJBC partnership will: (1) provide ac-cess to the best available evidence for patient safety inidentified priority areas, thereby facilitating an increasedawareness and knowledge about safety issues and currentresearch in the area; and (2) engage users in discussionsconcerning the applicability or appropriateness of the in-formation to their circumstances across the continuum ofcare. QJBC will conduct systematic reviews relevant topartner issues on priority patient safety topics identifiedby stakeholders. The QJBC Advisory Council representsa wide number of health sectors and networks in Canadathat will be instrumental in determining priority patientsafety issues. In addition, to the academic-policy partner-ship, QJBC is maintaining our regional academic-practicepartnership and we are meeting with nursing professionalpractice representatives locally to determine their patientsafety practice issues and research questions. QJBC willalso provide support and training for guideline adaptationto various contexts.

QJBC is well anchored within both academic and prac-tice domains. To be effective, it has brought together anacademic team with clinical expertise in various healthsectors, experience with different patient populations andhealth services domains, well-versed in epidemiology re-search and qualitative enquiry (Table 1). This table illus-trates the breadth of expertise in such an initiative and wasuseful to identify strengths and potential gaps within ourscholarship team. From our policy partners’ perspective, itidentified the range and type of experience they can drawupon. The grid may be helpful to other centers replicatingthe process.

When synthesis results indicate that changes in pol-icy may be required, QJBC in collaboration with its part-ners will draft and tailor briefs to present this informationat appropriate focused meetings, conferences, and polit-ical and decision-making forums. This is an area wherethe Partnership will actively guide knowledge exchangeactivity.



Figure 4. QJBC evalution model draft May 12, 2011.

Stakeholder DisseminationAll systematic reviews will be made available in their en-tirety in report format, including the scope of enquiry,findings and subsequent recommendations, and will beavailable through the QJBC Web site and on otherdiscipline-appropriate Web sites such as the Cochrane Li-brary, Joanna Briggs Institute, Accreditation Canada, andCPSI and/or other Web sites as appropriate. A brief sum-maries of systematic review recommendations, modeledon the JBI Best Practice Information sheets, will also beavailable for practitioners’ immediate. A needs assessmentwill be conducted through our partners to determine howbest to address remote and rural needs where informationtechnology may not be readily available. Other dissemi-nation modalities include peer-reviewed manuscripts, na-tional and international conferences and forums to accessa wide audience of practitioners, knowledge brokers, anddecision-makers.

To increase the application of research findings and up-take of research into practice, teams of practitioners fromdifferent healthcare organizations, for example, long-term

and community care, will be to a series of interactive edu-cational seminars that will be advertised on all PartnershipWeb sites. The objectives of these seminars will be to dis-cuss the findings and implications for practice. Feedbackfrom these sessions will in turn, inform strategies used inimplementation projects. Notably, our patient representa-tives will be invaluable to advise QJBC on strategies to raisesafety awareness through education that will reach patientpopulations.

A fundamental philosophical tenet driving QJBC re-lates to the importance of knowledge translation withthe next generation of practitioners. Patient safety pre-sentations will be tailored to undergraduate healthcarestudents (nursing, medicine, and rehabilitation science)beginning at our own university and working througheducational channels to champion this element. For ex-ample, during Patient Safety week in November 2010and 2011, we constructed patient safety focused studentlab sessions to highlight prevention of adverse events.A patient safety “room of horrors” with several scenar-ios was set up for students to test their knowledge and



TABLE 1Creating the right team: QJBC team profile

SYNTHESIS METHODOLOGICALEXPERTISE

RESEARCH PATIENT SAFETY CURRICULUMSCHOLARSHIP FOCUS EXPERIENCE EXPERIENCE EXPERTISE COCHRANE JBI OTHER

Psychiatric/mental health; Communityhealth nursing

X X X X

Psychosocial, Mental health/Gerontology X X X XNutrition & health, Public health,

PreceptorshipX X X

Research Director, Acute care X X X XRural health issues in Canada X X X XPediatrics & obstetrics, Continuity X X X X XSelf-care across multiple disease

groupings, synthesis evidenceX X X X X

Continuity of care; knowledge translation/complex populations

X X X X X X

Adult/elderly adult health X X X XEthics, health and nursing policy X X X XAcute medical-surgical care X X X XLibrary science (Health sciences) X XHealthy rural workplaces,

Inter-professional education & practiceX X X X X

Public health X X X XMedical-surgical nursing, Simulation X X XPain assessment management, Acute and

chronic pain, Bedside technologyX X X X X X

observation skills and recognize an error or adverse eventin the offing. The event was well-received by health sci-ences students and clinical faculty (Nursing, RehabilitationScience, Medicine, Pharmacy), and this event will be heldannually. QJBC is in a unique position to target our nextgeneration of patient care providers by developing patienteducation initiatives within the existing infrastructure ofthe academic environment. Both graduate and undergrad-uate students and clinicians are mentored through the sys-tematic review process, using the JBI methodology, thusraising awareness of patient safety issues while enhancingstudent/clinician skill and knowledge in the integrationand use of evidence for practice.

SUMMARY

By supporting improved use of all available patient safetyevidence to address questions of effectiveness, feasibilityand appropriateness of care, QJBC will engage in an in-tersectoral approach focused on the full continuum ofcare for patient safety. The initiative is founded on anacademic-policy partnership with a university (Queen’s),Accreditation Canada, the Canadian Patient Safety Insti-tute, and the CIHR to advance best practices in patient

safety, improve the quality and reliability of practice andultimately, health outcomes, through the use of best avail-able evidence. The QJBC alliance is focused on incremen-tally building a vibrant community of practice dedicatedto evidence generation and use for patient safety. It is anexperiment to work with national partners through an in-tegrated scholarship approach to be more responsive atthe policy level. Furthermore, it will benefit health servicesplanners and decision-makers, researchers, policy-makers,funders, healthcare providers, educators, and patientpopulations.

We hope to report back to Worldviews audiences on oursuccesses (and breakdowns) with such a partnership after afew years’ experience. We would also welcome feedback onthis approach and dialogue with other such collaborationsinternationally.

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