(Patient Harm from Patient Safety Events in Canada)
Setting the scene.
Your cousin, living in Vancouver has just informed you that he is getting married in two months time. He has invited you and your family to come from Toronto. You are thrilled and immediately contact Canada Rail to arrange for tickets. What follow is a recording of your conversation
You: Good afternoon! I need some information about travelling from Toronto to Vancouver by train, with my entire family, in two months. It’s for my cousin’s wedding!!
Canada Rail (CR) Agent: I can definitely help you. If you can tell me how many people are travelling and how old they are I can help you plan the best arrangement. When would you like to travel and are you flexible at all in the timing? Sometimes the tickets are a bit less expensive if you leave in the middle of the week. Also, will you need any help with accommodations in Vancouver?
You: So many questions! We are six altogether, my wife and two kids (age 6 and 8 years old – they are so cute!) and my parents, both in their 70’s. We can be flexible about the dates. I will ask my cousin – I think we can stay with some family members.
CR Agent: That’s excellent. Before we sort out the details there are a few things I need to share with you. This is because of our new T&FD policy.
You: T&FD? What’s that. I have never heard of it. I work in healthcare and we have tons of policies but I have never heard of one like that.
CR Agent: Not to worry. I will explain it fully. T&FD refers to the Transparency and Full Disclosure Policy (if you want you can look it up on our website – # 78144-18). Canada Rail believes you should know about all the risks and challenges that might be associated with your travel before you agree to take it on. It is sort of like when your doctor asks for your consent before starting an operation or procedure, after explaining the risks and advantages of the treatment.
CR Agent: First of all I can reassure you that our staff are all very well trained and highly experienced. They work in collaborative teams and support each other in their many tasks to make your travel experience a very positive one. That is like healthcare, I imagine, where all the staff, whether nurses, pharmacists, doctors, orderlies or administrators, come to work each day to do a good job.
You: Yes, we definitely try. Nobody comes to work to cause problems.
CR Agent: Glad to hear that! I can also tell you that our equipment is well maintained. Even when it is not brand new we work hard to keep it in top shape. It’s true that some of the trains are older but we generally use them on the shorter routes – not on the long transcontinental routes like the one you want to take.
You: That sounds like healthcare – lots of older well maintained facilities. Everybody doing their best for the patient with what is available.
CR Agent: So, as part of the T&FD policy (check it out – #78144-18 on the website) I also need to tell you that occasionally the equipment, especially the older trains, will break down and need to be repaired. When that happens we try to accommodate you as the travelling passenger – for instance if there is a long wait we would let you off the train so you could walk around and look at cows (if it happens in Saskatchewan) or mountains (in BC) or trees (northern Ontario). These little breakdowns are not every day and we strive to make the delay as short as possible….
You: Have you ever had to wait in a hospital emergency department? I wonder if the patients would appreciate the chance to look at cows?
CR Agent: Yes, well perhaps you should check with them. One other thing I have to mention as a result of our T&FD policy. Somewhere between Toronto and Vancouver, one out of every thirteen (1/13) passengers will experience some kind of event (I think in healthcare you call these adverse events?) with significant harm. Of course, our highly trained staff know exactly what to do in these situations, as long as they recognize that it is happening.
You: Whoa! 1/13?
CR Agent: Yes, well, we think it is important that you know about these issues. One last thing, of the passengers who experience an “event” one or two of them will be dead when they arrive in Vancouver. So let’s take a closer look at your dates – do you still want six tickets – four adults and two kids?
You do like your cousin and think you should make an effort to get to the wedding. While you appreciate the frankness of the T&FD policy of Canada Rail, perhaps you will explore other options – there are many other ways to get to Vancouver. For instance you could drive, or fly, or walk (too far), or hitchhike (a bit difficult with six people and quite risky apparently), or ride bicycles (where would you put the luggage and what about those Rockies?) or even take a slow boat through the Panama Canal. It is nice to have so many options. Doesn’t sound much like healthcare and those figures (1/13 passengers on a Canada Rail train will experience an adverse event) sound very much like what I read about in healthcare (I think it is called the Baker/Norton report). Something is definitely wrong with this picture….