Steven Lewis, Saskatoon, Saskatchewan

What does the public think?
André Picard, Montréal, Québec

André Picard presents his view of the economics of healthcare safety, suggesting that the problem is not the need for more money but for better managed care.

Assessing the economics of safer care
Ed Etchells, Toronto, Ontario

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What do we know? In this presentation, Ed Etchells will present a brief review of the literature and an estimate of the cost of unsafe care in Canada in 2010.

Lessons from aviation
Savik Ramkay, Toronto, Ontario

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How does an organization take on a new program of developing a safety culture when regulations are not yet in place? How do you convince investors that safety is more than best practices? Is it cost avoidance or does it increase the bottom line as an expense? An industry report and best practice story is a risk manager’s best friend when problem solving. Savik Ramkay will break down examples, such as the Texas City Disaster and a ‘simple’ runway overrun, to look at the workable lessons learned. Having worked with major airlines in Canada at the Charter and Cargo areas as well as smaller specialty organizations and regional carriers, Savik will describe the many lessons that can be shared about how each has become stronger and more willing to continue the journey down the Safety Management System road. This road ensures that the services they provide are delivered and that the employees are safe. After all, it makes good business sense to be safe!

Lessons from High Reliability Organizations
Kathleen Sutcliffe, Ann Arbor, Michigan

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A hallmark of High Reliability Organizations (HROs) is a well-developed safety culture that gives safety higher priority than other organizational objectives. Thus, it is often assumed that cost reductions are an enemy of high reliability. Safety in medicine, in contrast, is complicated because medical harm tends to be individualized, distributed and insidious. Consequently, other values, such as efficiency and cost control, typically receive higher priority than they might otherwise. In recent years, efficiency and cost control have been elevated even further and in some organizations consistently draw attention away from quality and safety. Balancing the efficiency-cost imperative and safety in healthcare is a significant challenge. The purpose of this presentation is to consider these issues and explore the implications using the lens of High Reliability Organizational theory. Although studies specifically examining the economics of High Reliability management are rare, the broader literature on HROs (particularly the literature on safety culture and learning) provides insights that may be valuable to healthcare providers, executives, and researchers.

Each of the three countries featured here reports uncontrolled and apparently uncontrollable healthcare spending. Yet each country has also established ways to improve quality and safety. In this session, we pose four questions for the presenters and participants:

1. What is each country’s model for improving quality and safety?
2. What does each country’s model offer that also saves money or limits spending?
3. Will any (or all) of these three models actually save real dollars that can then be used for something else, such as expanding previously deficient areas of healthcare or even for spending in areas unrelated to healthcare, such as roads, education or paying down debt?
4. Which of these options represents the best choice for Canadians?

The UK
Sir Michael Rawlins, London, United Kingdom

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The USA
Blair Sadler, San Diego, California

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Two Canadian views
Jim Hornell, Brandford, Ontario

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• Question 1: Where should the money come from – taxes, subscription fees, or point-of-care user fees?
• Question 2: How much of GDP should we spend? Is there a limit? Does it matter? Are all populations equal in their needs?
• Question 3: Would the 10% solution really work? Force the system to adjust and see what happens.
• Question 4: Does the answer lie in wasting less?
• Question 5: Should we simply pay more?

André Picard, Montréal, Québec

Steven Lewis, Saskatoon, Saskatchewan