Building a safety and quality culture in healthcare: where it starts.

Healthcare in Canada underachieves stakeholders' expectations for safe, high-quality care. The authors maintain that a common understanding of, and vision for, what is required to achieve improved outcomes for patients is missing. Educating tomorrow's healthcare professionals is paramount to address this critical shortfall. However, healthcare educational institutions must themselves break out of a 20th-century paradigm of viewing healthcare safety and quality as functions of individual healthcare providers rather than as properties of the clinical micro- and meso-systems within which they function and are a part. Canadian healthcare systems are ailing; like treating a sick patient, interventions should be grounded on a solid understanding of anatomy (structure) and physiology (function). The Healthcare Encounter Safety and Quality Model (HESQM) highlights the structures underlying healthcare delivery and the key system functions required to achieve safe, high-quality care. The model has been used to frame the University of Calgary Faculty of Medicine's educational strategy for achieving safer, higher-quality care. The HESQM is based on leadership - leaders whose decisions and actions are guided by core safety and quality principles. Today's and especially tomorrow's healthcare leaders require a common understanding of how to achieve higher-performing healthcare systems; it is the responsibility of Canada's post-secondary institutions to deliver it.