This month Physiotherapy Alberta shines our spotlight on Sandi Kossey, an Alberta physiotherapist who has gained national and international recognition as a leader in the area of patient safety and quality care. Sandi has put her experience as a physiotherapist and her passion for safe, effective, quality patient care to work as a senior director of the Canadian Patient Safety Institute (CPSI).
When asked about herself, Sandi’s answer provides some insight of the values that drive her personally and professionally.
“First and foremost, I am a citizen of Canada and Alberta, but I am also a wife, mother, sister, family caregiver and daughter,” says Sandi. “I carry these identities at all times, and I bring all these perspectives with me in my position as a health care leader provincially, nationally and internationally.”
Sandi says she is an improver by nature and feels this is an identity many physiotherapists can relate to and share. It is often what drives us into our profession.
Shortly after graduating from the University of Alberta (U of A) in 1998, Sandi said she worked with an “amazing interprofessional team where everyone was focused on providing the best care possible to their patients.” However, she began to identify things that challenged the team's ability to provide safe care and sometimes resulted in patients and/or providers suffering preventable harm.
Although Sandi could identify possible local or system solutions, she quickly discovered that implementing these solutions was often outside her control. Just speaking up was not enough to drive actual change. She realized she needed to take action and started looking for opportunities to become more involved in roles that had the authority to develop and implement needed changes.
Sandi started putting her hand up to become involved in quality improvement projects and quickly became the youngest senior physiotherapist in the Capital Health Region. When she left clinical work, and moved into management roles, she led the development and implementation of a couple of projects physiotherapists will be familiar with, the Alberta Provincial Stroke Strategy and the AHS Safe Patient Handling initiative. Her background in physiotherapy and her experience working with frontline clinical teams were invaluable in these positions and ensured the rehabilitation perspective was presented in all discussions.
After a short stint working within the provincial education sector, using her experience in health care and quality improvement to address employee health and wellness, Sandi realized how much she missed health care and knew she would prefer to work on improving health-care delivery in its entirety. In 2007, Sandi accepted a position with CPSI. She had found the “perfect environment” to focus on her passion and truly improve health outcomes on a large scale. CPSI’s provincial, national and international platforms connected her with a broad and diverse audience and expanded the impact she could have to effect change.
Along the way, Sandi has maintained her connection to her profession through volunteer activities with the Canadian Physiotherapy Association and Physiotherapy Alberta. She continues to be a guest lecturer for the physiotherapy program at the U of A.
Her many roles
As the Senior Director of Strategic Partnerships and Priorities with CPSI, Sandi works with a pan-Canadian team of professionals in a federally funded, not-for-profit organization. CPSI’s sole mandate is to address patient safety and reduce preventable harm in health care to improve patient and provider experiences and outcomes.
Over the last 12 years, Sandi has witnessed significant improvements in patient safety and learned a great deal about quality health care. However, statistics show there is more to do to reduce the magnitude and burden of harm across all care settings. Preventable harm incidents have reached epidemic levels and are the third leading cause of death in Canada behind cancer and heart disease. Every 13 minutes and 14 seconds someone receiving care in Canada will suffer preventable harm.1
Sandi’s current national portfolio is focused on improving accountability at all levels within the health care system. She works with policymakers, health care leaders, and patients through strategic partnerships and alliances across all health-care sectors and at all government levels. Some of the strategies she is involved with include:
Educating the public to ask questions, speak up and become active members of their care team.
Educating health-care professionals about their role and responsibility to ensure patient safety, by speaking up and addressing safety issues.
Working with health-care regulators to ensure they are upholding their role to enable safe, effective patient care.
Working with health system leaders to develop and implement policy that supports a culture of patient safety and enable the delivery of safe patient care.
Working with all levels of government to develop legislation to support a culture of patient safety.
Working with all stakeholders to ensure patients and families are an integral part of every care team.
Sandi is also the Director of the World Health Organization (WHO) Collaborating Centre for Patient Safety and Patient Engagement. In this role she provides expertise and technical advice to WHO and WHO member states regarding patient safety and effectively partnering with and engaging patients.
Through her job with CPSI Sandi also supports a network of patients and families who have personal, first-hand experience with preventable harm. The Patients for Patient Safety Canada volunteers draw from their own experiences to partner and advocate for improved health-care systems at all levels, bringing a personal perspective to the table.
Finally, Sandi has a legislative appointment to the Board of Directors of the Health Quality Council of Alberta (HQCA), an organization with a mandate to improve patient safety and health service quality in our province. She uses her expertise from her day job and her personal experiences as a citizen of Alberta to inform discussions and decisions that govern the HQCA.
Lessons learned, rewards realized
The first lesson Sandi has learned along the way was patience. As an improver at heart, Sandi wants to see change happen quickly. Overcoming her frustration with the slow pace of change is one of the greatest challenges she faces. She reminds herself that, regardless of whether you are looking for a change in your patient, change in a hospital system or change at a global level, change takes time.
She realizes that you need to celebrate small changes and know that moving forward, even with baby steps, is a win for patient safety and engagement.
The second lesson learned was that communication is key! Sandi reiterated that the importance of good, clear communication cannot be underestimated. The evidence identifies poor communication as a key factor in most preventable harm events. It is no less important when identifying the “true north” for the projects and initiatives Sandi works on and trying to create a shared vision within a diverse group of stakeholders. She indicated that this takes patience, humility and a great deal of active listening to understand where everyone is coming from, what their vision and goals are, and how to align these within a common purpose and plan.
The final lesson she has learned is more personal in nature. Sandi now recognizes the value of thoughtful self-reflection to guide you as a leader. In Sandi’s experience you learn as much from failure as you do from success. Failure often precedes success and is simply a step-in learning. She feels leaders need to show humility and allow themselves to be vulnerable in order to lead well and to foster leadership in others. Sometimes you need to take a chance, trust in others, and ask for help.
Sandi highlighted two key rewards from her work:
She said the most personally rewarding part of her job is having the privilege of working with and supporting the individuals who volunteer with Patients for Patient Safety Canada. These selfless and generous individuals volunteer their time and become involved in championing health-care improvement after something has gone terribly wrong in their lives. To see them be included as valued partners in health-care discussions and decisions and to assist in giving them a voice and making a difference is the most rewarding part of her job.
Sandi also identified the opportunity to represent her profession and country by collaborating and providing leadership within the World Health Organization (WHO) as contributions to patient safety that she is proud of. Sandi assisted with drafting the World Health Assembly’s resolution on Global Action on Patient Safety that passed in May 2019. Another recent highlight was her involvement in shaping and creating the first World Patient Safety Day on Sept. 17, 2019. She is also looking forward to contributing to drafting the agenda documents for the next G20 meetings with the goal of increasing the level of awareness, agreement, and commitment of political leaders to patient safety and patient engagement.
How does her training as a physiotherapist contribute to these roles?
When I asked how being a physiotherapist has contributed to her current role, Sandi said she constantly draws from her experience both as a frontline clinician and as a manager and feels that looking at situations from her multiple perspective guides her in all her roles. She has not forgotten the challenges faced by clinicians on a daily basis as they work to provide the best care possible to patients. Competing demands, time, complexity, and system barriers all affect the ability to provide safe, effective care. During any discussion or when making decisions, she keeps in mind how she felt when she saw things that could be changed or had solutions to present but lacked the authority to implement changes for improvement. Sandi also said she remembers what it felt like to have a change thrust upon her with no understanding of the reason for the change. She feels it is vital to keep this perspective and remind herself that real change must happen at the individual level first and that policymakers and managers must support change through a culture of patient safety and engagement.
What can individual members do to support a culture of patient safety?
She emphasized the personal and professional obligations of physiotherapists to speak up and be heard when they identify safety risks, witness potentially harmful situations or when actual harm is occurring. Identifying problem areas or processes and offering suggestions for real-time solutions is a responsibility we all have and doing something about the issues we see, taking action is where we can all make a difference. Physiotherapists are improvers and can bring that skill set to discussions at any level.
Her final thought was to encourage members to be aware of patient safety and make it an explicit priority. Get involved, ask questions and participate in driving change and improvement that creates a culture of patient safety and engagement at all levels. We all need to speak up for patient safety. You can donate your voice by sharing your stories of health-care harm and share your advice to help others learn from your experience at conquersilence.ca Together we can #ConquerSilence in our health-care system. Your voice matters and can help save lives.
RiskAnalytica. (2017) The Case for Investing in Patient Safety in Canada. Available at https://www.patientsafetyinstitute.ca/en/About/Documents/The%20Case%20for%20Investing%20in%20Patient%20Safety.pdf Accessed Dec. 11, 2019.
Patient Safety. Every Person. Every Time.
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.