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The Costs of Developing, Implementing, and Operating a Safety Learning System in Community Practice

O’Beirne, Maeve MD, PhD*; Reid, Robert MD, PhD; Zwicker, Karen BScH; Sterling, Pam BSc, PMP; Sokol, Ellen BHSc; Flemons, Ward MD; Baker, Ross PhD§; Clement, Fiona PhD

doi: 10.1097/PTS.0000000000000052
Original Articles

Background The cost of implementing safety systems in primary care has not been examined. One type of safety system is a safety learning system (SLS). An SLS has 2 components: a reporting that monitors patient safety incidents and a learning component that facilitated the development and implementation of improvement strategies. It is important to understand the costs of an SLS to determine if the improvement program is financially sustainable.

Objective To determine the costs of the development, implementation, and operation of the community-based SLS.

Methods Nineteen participating family physician clinics in Calgary, Alberta, were included (15 urban and 4 rural) consisting of 47 physicians, 53 office staff, 18 nurses, and 6 clinic managers. Costs of the SLS were determined by the ingredient method using micro-costing. The costs were divided into 3 stages: development, implementation, and operational. Development costs were processes required to create and initiate the SLS. Implementation costs were accrued as a result of establishing, running, and refining the SLS. Finally, operational costs were those related to maintaining the SLS. Costs were further broken down into fixed, marginal, and in kind; this approach will allow policy and decision makers to apply the appropriate costs to their own settings.

Results The total development, implementation, and operational costs for the SLS in Canadian dollars were $77,011, $19,941, and $166,727, respectively, with a total cost of $263,679 over approximately a 4-year period. During this time, 270 incident reports were submitted, and 54 improvement cycles were implemented.

Conclusions The results provide quantitative data, which could be useful to legislators, policy makers, and other private and public sector payers of patient safety programs in determining the overall sustainability of an SLS.

From the *W21C Research Centre, Calgary, Alberta, Canada; †Group Health Research Institute, Group Health Cooperative, Seattle, Washington; ‡University of Calgary, Calgary; and §University of Toronto, Toronto, Canada.

Correspondence: Maeve O’Beirne, MD, PhD, W21C Research Centre, G-01 TRW Building, 3280 Hospital Drive NW, Calgary AB, Canada, T2N 4Z6 (email:

The authors disclose no conflict of interest.

Funding: This project is funded by Alberta Heritage Foundation for Medical Research, Canadian Health Services Research Foundation and Canadian Patient Safety Institute.

© 2013 by Lippincott Williams & Wilkins