Striving for High Reliability: The Next Frontier in Patient Safety

Saturday, 28 October 2017

Patti Ludwig-Beymer, PhD, MSEd
Administration, Edward Hospital, Naperville, IL, USA
Patricia Jones Fairbanks, MSN
Nursing Administration, Linden Oaks Hospital, Naperville, IL, USA

High Reliability Organizations (HROs) conduct relatively error free operations over long periods of time and consistently make good decisions about quality and operations. Healthcare organizations have struggled with being highly reliable because of the complexity of health care. A small health system with two acute care community hospitals and a behavioral health hospital embarked on a journey to high reliability by implementing the five principles of HROs: preoccupation with failure; reluctance to simplify; sensitivity to operations; commitment to resilience; and deference to expertise. A goal related to high reliability is included on the system strategic plan, and a system level team chaired by the two acute care hospital chief nursing officers meets monthly to foster the HRO quest.

Based on evidence related to the science of safety, leadership training has focused on leading with safety; finding and fixing system problems; and building and reinforcing accountability. As part of leading with safety, each meeting begins with a safety topic or story. Leaders encourage, reward, and expect staff to report safety events; expect staff to ask safety questions; and recognize and support staff when they do. As part of finding and fixing system problems, each hospital conducts a daily safety huddle. Safety issues are identified and addressed immediately. As part of building and reinforcing accountability, leaders provide instant feedback and constant reinforcement; apply a just algorithm when errors occur; and conduct frequent rounds. Weekly inter-professional safety rounds include individuals from compliance, facilities, housekeeping, infection control, materials management, nursing, regulatory, accreditation, and safety. A member of Senior Staff meets regularly with staff to discuss the unit’s priorities for and concerns about patient safety.

 The nursing vision and strategic plan reinforce HRO principles. Nursing’s involvement includes hourly rounding and bedside report. Inter-professional education is being planned for physicians, nurses, and all employees. The safety scorecard includes hospital acquired conditions and the serious safety event rate. The Culture of Safety Survey (Agency for Health Care Research and Quality) is being used to assess staff’s perspective of safety.