Improvement still needed on hospital harm: CIHI

OTTAWA – For the fifth consecutive year, the rate of unintended harm experienced by patients in Canadian hospitals has remained stable at 6%, according to the Canadian Institute for Health Information. The latest data shows that in 2024–2025, patients experienced at least one instance of harm in 1 out of every 17 hospitalizations. This figure represents about 153,000 hospital stays out of a total 2.6 million. And in a quarter of those cases, multiple harmful events occurred.

While rates of unintended harm haven’t worsened, this number highlights the ongoing need for system-wide efforts to make hospitals safer for patients.

Measuring patient harm in hospitals isn’t about fault-finding. It’s about strengthening a culture of safety and transparency in Canada’s hospitals.

“Measuring patient safety is not an easy endeavour,” says Yana Gurevich, manager, health indicators and client support, CIHI. “Mature data systems are needed to capture patient harms. That, and a very strong patient safety culture to report incidents of harm without facing repercussions, so that others can learn from the experience. Canada’s information reporting system is among the best.”

Still, under-reporting of hospital harms remains a challenge. “Hospitals are complex places with lots of activity going on,” Gurevich explains. “We need reporting and an elimination of the fear of blame and shame, so that we can continuously be learning and preventing future harms.”

What does “unintended harm” mean?

CIHI’s Hospital Harm indicator tracks 31 different potentially preventable harms to patients. Of these, a small group of conditions makes up the majority of cases. Two-thirds of harmful events recorded in our most recent analysis are

• Electrolyte and fluid imbalance
• Urinary tract infections
• Delirium
• Pneumonia
• Aspiration pneumonitis (lung inflammation as a result of inhaling a substance)
• Post-procedural infections

While some harmful events may seem minor, their impact is significant. Patients who experience a harmful event stay in hospital, on average, five times longer than those who do not — 28 days compared with six.

In addition to the impact on patients and their families, unintended harms are costly for Canada’s health care systems. Hospitalizations where a patient experienced unintended harm cost four times more — an average of $44,641 per hospital stay, compared with $9,729 for patients who did not experience harm.

A national effort to make hospitals safe

The Hospital Harm Project is a collaboration between CIHI and Healthcare Excellence Canada (HEC). It links measurement of unintended harms with improvement tools that give hospital executives, clinicians and policy-makers the data and resources they need to prevent patient harm.

HEC’s Hospital Harm Improvement Resource complements the Hospital Harm indicator developed by CIHI. It links measurement and improvement by providing a curated list of evidence-informed practices that will support patient safety improvement efforts.

“Whether you deliver care, support a loved one or are navigating the system yourself, your actions matter,” said Denise McCuaig (pictured), executive director, healthcare transformation and capacity building, HEC. “By making space for all voices, we can make healthcare safer for everyone.”

When things go wrong it’s usually down to multiple, complex factors, patient safety experts say. But 21 years after a report known simply as the Baker-Norton report estimated as many as 23,000 people die in Canada’s acute-care hospitals each year from adverse events, “we’ve taken our eyes off the ball,” Dr. Ward Flemons, a professor of medicine at the University of Calgary told the National Post newspaper.

When the Baker-Norton report – by the University of Toronto’s Ross Baker and Peter Norton of the University of Calgary – came out, “it shook everybody and woke everybody up” from hospital boards and CEOs to medical and nursing stations, Flemons said.

“There was a lot of focus on patient safety, but, like any initiative, it fades over time if there isn’t a constant pounding of the drum.”

Throw in COVID, “and it took focus away from, how do we make current care better, to, how do we keep people alive during a horrible pandemic?”

But Canada is also one of the few countries in the world without a national patient safety plan, efforts at improving hospital safety are “fragmented, and for the most part, voluntary,” and there’s no concerted spotlight on safety, Baker and co-author Leslee Thompson write in Healthcare Quality.

Rather, it’s “much like a game of snakes and ladders,” they said. “We make advances, but too often we slide back due to shifting priorities, insufficient funding and resource capacity,” they said.