Historical Overview: Pivotal Studies Catalysts for Change

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This section provides an overview of how the quality and safety agenda in health care has been informed by evidence and research. Also highlighted is how this evidence has influenced legislation and ensured broader system accountability.

At the end of this section, the learner will understand

  • the shifts in philosophical approaches to Quality over time.
  • how research and evidence have informed the advancement of quality in health care and informed broader organizational and system change
  • the urgency of addressing quality and safety in the Canadian health care system.
  • why there is a shift in focus from individuals to the broader system when addressing quality and safety.
  • the legislation that ensures health care organizations take accountability for quality in Health Care.


Lecture Video: Historical Overview: Pivotal Studies Catalysts for Change (7:38)

Slides: Historical Overview: Pivotal Studies Catalysts for Change


Activity # 1

This brief article summarizes the findings of the Institute of Medicine (IoM) report and highlights the contributing factors and consequences of error in health care. As you review this summary, identify those contributing factors and consequences.

Institute of Medicine  (1999). To Err is Human: building a safer health system. Washington D.C., USA  Author


Activity # 2

This article describes the Canadian Adverse Events Study and summarizes its findings. As you review this article reflect on what systems and processes in health care might contribute to these adverse events.

Baker G.R., Peter G. Norton P.G. et al. (2004) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ,  170(11), 1678-1686; DOI: 10.1503/cmaj.1040498


Activity # 3

Review this summary of the Excellent Care for All Act. Can you identify elements of this that are visible in your organization? If you do not work in a hospital, identify a local hospital and review its website in order to identify these elements.


Check Your Understanding


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Leadership for Nurses in Clinical Settings Copyright © 2022 by Dr. Kirsten Woodend, Dr. Catherine Thibeault, Dr. Manon Lemonde, Dr. Janet McCabe is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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