Are we afraid to use regulatory and policy levers more aggressively to optimize patient safety?

Context Healthcare is a very labour-intensive process. The performance, individually and collectively, of a diverse array of healthcare workers has profound implications for the safety of care provided to patients and clients. It is worthwhile to consider how effectively we have used regulatory and policy levers over the past 10 years to assure optimally safe performance by the entire healthcare workforce. In any consideration of human performance, it is important to differentiate between human capacity to perform at a high level and the consistency of actual human actions on a day-today basis. It is important to remain ever mindful of the factors that influence performance capacity and those that influence workplace actions. In 1990, George Miller published in Academic Medicine, an article that described four facets of professional expertise and visually depicted these facets as layers of a pyramid (Miller 1990). In Miller’s Pyramid, “knows” forms the base, followed sequentially by “knows how,” “shows how” and “does.” Although Miller applied this construct to professionals, I believe it is applicable to all workers. Patient safety is compromised when there is a gap between worker capacity to perform safely (know how) and actual worker performance (does). Both regulatory and policy levers can narrow that gap if they are applied effectively. Historically, we have applied regulatory and policy levers quite differently to professional workers as opposed to non-professional workers. We have also applied these levers differently to healthcare system employees as opposed to workers who hold independent contractor status in the system. I will explore some of the implications of our differential application of regulatory and policy levers to different categories of healthcare workers. I will also issue a challenge to reconsider how such levers might be used more effectively in the future to enhance patient safety in Canada.