Bill 40 overhauls the Health Quality and Patient Safety Act by expanding definitions, creating a New Brunswick Quality of Care and Patient Safety Advisory Committee, and requiring standardized incident management and quality improvement reporting across health care organizations. It makes quality reviews mandatory for defined critical events and multiple‑patient events, requires prompt disclosure to affected patients, and centralizes data sharing and oversight under the Minister of Health.
The legislation matters because it shifts several levers from local hospital committees to provincial oversight: standardized surveillance, mandatory reporting timelines, and ministerial authority to impose standards, directives and funding conditions. Organizations will need interoperable incident-management systems and new governance routines; patients and advocates will see clearer rights to information and protected apology provisions, while the Minister gains tools to aggregate and act on system-level safety data.
At a Glance
What It Does
Bill 40 broadens statutory definitions (e.g., 'critical event', 'harm'), establishes a provincial Advisory Committee, makes quality reviews mandatory for critical and multiple‑patient events and requires health care organizations to produce annual quality improvement plans and reports. It requires standardized surveillance through an incident management reporting system and authorizes the Minister to set standards and require disclosures to improve safety.
Who It Affects
Regional health authorities, hospitals and other designated health care organizations; quality-of-care committees and boards of directors; the Department of Health and the new Advisory Committee; CIHI and safety registries (through prescribed surveillance reporting); and patients, families and their representatives who are entitled to incident information.
Why It Matters
The bill centralizes patient-safety oversight and data flows, creating system-level comparability and the ability to direct corrective action. By tying compliance to funding and giving the Minister broad disclosure powers, it shifts the balance toward provincial coordination — with practical implications for compliance, IT systems, governance and public disclosure practices.
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What This Bill Actually Does
Bill 40 starts by tightening and adding key definitions. It defines 'critical event' and 'multiple‑patient event' and clarifies 'harm' and 'quality assurance' material so the scope of incidents that trigger mandatory action is broader and more precise.
The bill also clarifies that a health care organization may determine, on a balance of probabilities, whether an incident contributed to a patient’s death.
On process, the bill requires the staff member who discovers an incident to submit an incident report to the health care organization 'as soon as the circumstances permit.' Health care organizations may conduct quality reviews when an incident report is filed, but they must conduct reviews for all critical events and multiple‑patient events. Incidents involving two or more organizations require joint quality reviews; the resulting quality review report must be approved by the quality-of-care committee and shared with the board of directors.The legislation strengthens disclosure to patients: organizations must notify patients if the incident caused harm or presents an ongoing safety risk and, when available, provide the incident facts, required treatments and the approved committee recommendations.
Organizations must also produce and carry out annual quality improvement plans and submit quality improvement reports; the Minister can set the content, timelines and standards for those plans and reports and may require specific quality improvement activities.On data handling and oversight, the bill declares quality assurance and surveillance information confidential while specifying many exceptions: organizations may disclose non‑identifiable reports and indicators, regulatory bodies may receive de‑identified QA information, the Minister may require surveillance information useful for system improvement, and the new Advisory Committee may receive specified data. The Act explicitly prevails over the Right to Information and Protection of Privacy Act where they conflict.
Finally, the bill adds operational rules in regulation: mandated incident-management reporting systems, standardized definitions and taxonomies, timelines for annual plans/reports and phased requirements to supply surveillance data to national repositories such as CIHI and ISMP.
The Five Things You Need to Know
Staff must submit an incident report to their health care organization 'as soon as the circumstances permit' after discovering a patient safety incident.
The bill requires a mandatory quality review for any 'critical event' or 'multiple‑patient event' and forces joint reviews when such incidents involve two or more organizations.
Health care organizations must submit an annual quality improvement plan and an annual quality improvement report; the regulation sets the deadline at within 40 business days after the fiscal year ends and gives the Minister discretion to extend deadlines.
Quality assurance and surveillance information is confidential but the Act allows disclosure of non‑identifiable reports and performance indicators, requires disclosure to the Minister and authorizes the Advisory Committee to receive data; the Act also prevails over the Right to Information and Protection of Privacy Act in conflicts.
The definition of 'critical event' includes 'never events' as determined by the Minister for hospital care, and the Act permits a health care organization to decide, on a balance of probabilities, that an incident contributed to a patient's death.
Section-by-Section Breakdown
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Expanded and clarified definitions (critical event, harm, surveillance)
The bill revises section 1 to add and refine terms central to the Act's operation: 'critical event', 'multiple‑patient event', 'harm', 'quality assurance information', 'surveillance information' and 'performance indicator'. Those definitions raise the threshold for mandatory responses (critical events) but also broaden what qualifies as actionable safety data (surveillance and quality assurance information). Practically, this forces organizations to map their incident inventory to the new taxonomy and to capture different data types (microdata vs. aggregated indicators).
Creates a provincial advisory body with prescribed powers
The Minister must establish the New Brunswick Quality of Care and Patient Safety Advisory Committee and regulations will set its powers, duties, membership and composition. The regulation requires the committee to include executives responsible for quality and at least one patient or family member. The Advisory Committee becomes the provincial forum for recommendations and a recipient of quality assurance and surveillance information under the Act, giving it an explicit role in system‑level advice and coordination.
Incident reports trigger optional or mandatory quality reviews; joint reviews required for multi‑organization critical events
Staff must file incident reports promptly; organizations may conduct quality reviews after any report, but the bill makes reviews mandatory for critical events and multiple‑patient events. Where incidents cross organizational boundaries, the bill requires joint reviews and joint reports. Committees must review quality review reports, approve recommendations, and notify boards — institutionalizing a closed loop between frontline reporting, committee approval and board-level oversight.
Stronger patient disclosure duties and mandatory QI planning with ministerial enforcement powers
Health care organizations must notify patients who suffered harm or face ongoing safety risks, disclose incident facts and required interventions and may share committee recommendations and subsequent quality improvement activities. Organizations must submit quality improvement plans and reports and carry out minister‑required activities. The Minister can approve and direct funding for QI activities, impose conditions on funding, and withhold payments when organizations do not comply — creating a financial enforcement mechanism tied to quality processes.
Confidentiality is the baseline but with detailed disclosure exceptions and supremacy over privacy law
The bill designates quality assurance and surveillance information as confidential but enumerates exceptions: organizations may disclose non‑identifiable reports and indicators; health regulatory bodies can receive certain QA data; the Minister may request surveillance information for system improvement; and the Advisory Committee can receive QA and surveillance data per regulations. The Act also states it prevails over the Right to Information and Protection of Privacy Act where inconsistent, concentrating control over disclosure decisions in this statute and in ministerial/regulatory instruments.
Broad protections for internal reviews and apologies to encourage candid reporting
Statements, opinions or evidence produced under the Act are inadmissible in court or administrative proceedings except for perjury at trial, insulating internal review material from use in most legal actions. The bill also defines and protects apologies: they do not constitute admissions of fault, do not void insurance coverage and are not admissible as evidence of liability in civil or administrative proceedings, aiming to reduce fear of legal consequences and promote open communication with patients and families.
Operational requirements: incident-management systems, committee terms, timelines and national reporting
Regulatory changes require health care organizations to maintain incident‑management systems using standardized definitions and taxonomies set by the Minister and to disclose specified QA and surveillance data to the Advisory Committee within ministerial timeframes. The regulation fixes operational deadlines: quality improvement plans and reports must be submitted annually (within 40 business days after fiscal year end, unless the Minister grants an extension). It phases in data flows to national repositories — requiring regional authorities to transmit discharge abstracts to CIHI's NACRS and medication incident data to ISMP Canada on set dates.
Phased start dates for national reporting obligations
The Act sets two commencement dates for regulatory reporting obligations tied to national repositories: disclosure through NACRS comes into force April 1, 2027, and disclosure to the Canadian Medication Incident Reporting and Prevention System comes into force December 1, 2027. These dates give regional authorities a fixed window to prepare systems for those specific national feeds.
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Explore this topic in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Patients and family members — the bill requires prompt notification when incidents cause harm or pose ongoing risk, access to incident reports on request, and clearer communication of recommended restorative actions.
- Patient advocates and patient representatives — the Advisory Committee must include at least one patient/family member, creating a formal channel for lived‑experience input into provincial recommendations.
- Provincial system planners and the Department of Health — centralized surveillance, standardized taxonomies and mandated reporting provide richer, comparable data to detect trends and target interventions.
- National safety registries and health databases (CIHI, ISMP Canada) — the Act mandates phased reporting to national systems, improving data completeness and national benchmarking.
- Quality committees and boards that already have mature QA processes — organizations with established incident-management systems and governance are positioned to meet new standards with less disruption and may avoid funding sanctions.
Who Bears the Cost
- Health care organizations (hospitals, clinics) — they must implement or upgrade incident management systems, collect and transmit standardized surveillance data, run quality reviews, prepare annual QI plans/reports and absorb staff time and IT costs.
- Regional health authorities — specific obligations to report to CIHI and ISMP require mapping, integration and possibly new staffing or vendor contracts to meet national formats and phased deadlines.
- Boards of directors and quality committees — they face increased accountability to review and approve quality review recommendations and to monitor implementation, with potential governance liabilities if recommendations are not acted on.
- Department of Health — the Minister’s expanded role in approving funding, setting standards and receiving system data increases departmental workload and requires investments in analytics, secure data handling and committee support.
- Smaller providers and non‑acute facilities — they may lack capacity for standardized reporting and could face disproportionate administrative burdens or need to purchase shared systems or outsourcing solutions.
Key Issues
The Core Tension
The bill tries to reconcile two legitimate but competing goals: protect internal, candid quality reviews to encourage learning and system improvement, while providing patients and the public with meaningful transparency and external accountability. Giving the Minister centralized powers and using funding as enforcement strengthens system oversight but risks politicizing disclosure decisions and imposing heavy technical and administrative costs on frontline providers.
The bill builds most of its practical effect into regulation and ministerial discretion. Many operationally crucial details — exact taxonomies, which performance indicators will be required, what the Advisory Committee may see and the precise triggers for public notice — are left to regulation or to the Minister's determinations.
That means the Act sets direction but the real boundaries of disclosure, timelines and data elements will be decided later, creating implementation risk and uncertainty for organizations planning investments now.
A central implementation challenge will be interoperability and cost: the Act mandates standardized incident‑management systems and phased reporting to national repositories (CIHI, ISMP), but it does not fund those upgrades. Smaller organizations may struggle to meet the 40‑business‑day reporting windows and the technical requirements without provincial supports or coordinated procurement.
The Minister’s power to withhold funding creates leverage for compliance but raises questions about proportionality, dispute resolution and the impact of funding interruptions on patient services.
The confidentiality regime and broad inadmissibility protections aim to encourage candour, but they also narrow the information available for public accountability. The Act's supremacy over the provincial access-to‑information law concentrates disclosure decisions within the health architecture; this will satisfy advocates for protected learning environments but frustrate those seeking independent scrutiny.
Finally, authorizing organizations to decide, on a balance of probabilities, whether an incident contributed to death could have mixed legal and ethical consequences when families or coroners reach different conclusions.
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