Governance, policy and system-level efforts to support safer healthcare.

Over the past 10 years there have been concerted efforts across Canada to create safer healthcare systems both by improving practices at the frontline and by creating an environment that encourages the development of effective safety practices and a safety culture. There have been major changes in organizational policies regarding the disclosure of adverse events to patient and families, the reporting of patient safety incidents to facilitate learning, and new accreditation requirements. Governing bodies for healthcare organizations have been given clearer accountabilities for quality of care and patient safety, and improved performance measurement, greater engagement of patients and families, and a trend toward greater transparency have aided efforts to improve patient safety. However, some areas where changes were anticipated, including the reform of medical liability processes and changes to regulations that govern health professional practices have not progressed as much as some expected. Overall, a decade following the release of the Canadian Adverse Events Study and the creation of the Canadian Patient Safety Institute many healthcare organizations have made only limited progress toward the creation of "a culture of safety" and a safer healthcare system.