Paper
Sunday, November 4, 2007
292
Becoming a High Reliability Organization: A Multidisciplinary Project
Patricia A. Heale, MSN, RNC, Maternal-Child Health, Newton-Wellsley Hospital, Newton, MA, USA and Barbara Powell, BSN, RNC, Maternal-Child Health, Newton-Wellesley Hospital, Newton, MA, Algeria.
| Learning Objective #1: discuss the elements of a high reliability organization in the health care setting. |
| Learning Objective #2: identify the changes neccesary to develop a high reliability perinatal unit |
Over the past several years the Joint Commission on Accreditation of Healthcare Organizations published a list of patient safety goals. At the same time many authors were discussing the notion of high reliability organizations based on the concepts of Crew Resource Management (CRM) heralded by the airline industry since the 1970’s. High reliability organizations exemplify a systems approach to managing error. The focus is on what system or process failed not on the individual making the error. High reliability organizations are notable for having a collective preoccupation with the possibility of failure among all team members’: physicians, midwives, nurses, dieticians, patient care assistants, housekeepers, etc. In order to move towards these ideals Perinatal Team Training (PTT) evolved as a two-hour mandatory course for all members of the multidisciplinary perinatal team. The goal of PTT was to build highly coordinated perinatal care teams. Creating this type of work environment would necessitate systematic training in teamwork and communication and the efficient management of critical events. PTT consisted of education regarding human factors and error management, team structure and climate, effective communication, situational awareness, and team skills. As a result of PTT the organization is moving closer to the goal of becoming a high reliability organization. PTT has provided the basis for several changes in perinatal practice including the use of structured and closed-loop communication between team members, multidisciplinary safety rounds, ongoing emergency drills such as mock codes, and the adoption of standardized terminology for fetal monitor strip interpretation. Ongoing education reminds team members that a commitment to safety is required throughout the organization and that shared values and beliefs are present at all levels within the organization. The perinatal unit shows improved teamwork, openness concerning errors, and a commitment to reporting problems, incidents, and near misses.