15. Leveraging partnerships to support large scale adoption of quality and safety best practices (Panel)

Learning objectives

Describe the characteristics of purposeful partnerships to ensure scale, spread and adoption of best practices;

Explain how co-developed resources and knowledge translation activities can improve quality and safety at the practitioner, team and system levels;

Describe the system, leadership and team/practitioner benefits associated with undertaking a risk assessment.

Activities, methods, innovations

HIROC became the insurer for Ontario’s registered midwives in 2003; and Indigenous midwives under the exception clause in 2018. As innovators in risk management and safety, the partners are committed to leveraging learnings from Canadian midwifery claims data to improve the quality and safety.

In 2011 HIROC translated its claims data into several key resources aimed at strengthening healthcare safety. This included: a list of the top risks leading to the most costly claims in hospitals; risk reference sheets for each risk; and, the Risk Assessment Checklists (RAC) Program.

In consultation with the AOM, HIROC applied this approach to Canadian midwifery claims. The first midwifery-focused iteration of RAC included 17 modules; the second cycle included 10 modules.

Outcomes, results

Coordinated by the AOM, by March 2018 over 700 Ontario registered midwives, 80 midwifery practice groups, and two birth centres completed the first three-year RAC cycle. From a provincial lens, midwifery modules with the highest percent change in the average implementation score between years 1 and 3 included healthcare acquired burns (163%), interprofessional/hospital conflicts (100%), management of client concerns/complaints (79%), and hyperbilurbinema (56%).

Results helped prioritize AOM risk, quality and safety initiatives such as educational events, clinical practice guidelines, mobile applications, and charting forms.

The 2018/19 iteration of the Canadian midwifery risk ranking and module set was finalized in September. Ontario midwives, practice groups and birth centres will be starting their second RAC cycle late 2018.

Leadership lessons learned

Midwifery is a discipline that values continuity of care, informed choice, choice of birthplace, and appropriate use of technology. It fosters a collaborative approach to healthcare, facilitating relationships with clients and healthcare partners. Midwifery increases self-determination of new parents –  inspiring confidence during the early stages of parenthood.

This collaboration between a health profession association (the AOM) and a liability insurer (HIROC) is the first of its kind in Canada. It works because both organizations start from one common goal – improving the quality and safety of patient/client care.

Faced with competing priorities and financial constraints, healthcare leaders are challenged with prioritizing improvement opportunities. The results of this collaboration provide system and leadership learnings that can be replicated by other organizations and healthcare disciplines.

System changes

This partnership demonstrates the benefit of knowledge sharing and co-development of a risk assessment tool to identify successes and prioritize improvement areas in midwifery care. Recreating what works and acting on opportunities for improvement may reduce the high cost of errors and patient safety incidents and, most importantly, benefit midwifery clients and their newborns.


This panel will demonstrate how the AOM HIROC partnership – a unique leadership and system change case study – contributes to obstetrical quality improvement and safety in Canada. The panel will speak to system and leadership learnings applicable to the acute and non-acute care settings and diverse health professions.


Allyson Booth AOM – Association of Ontario Midwives

Elizabeth Brandeis – Association of Ontario Midwives

Catherine Gaulton – HIROC

Joanna Noble – HIROC




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