High reliability organizations are organizations that operate in complex, high-hazard environments for extended periods without serious accidents or catastrophic failures. This concept is particularly applicable to health care given that failures can be life-threatening. While high reliability is often thought of as effective standardization of processes, an HRO is better defined as a condition of persistent mindfulness within an organization.
Patients and their loved ones expect medical care they can rely on. As a High Reliability Organization (HRO), prioritizing a safe and error-free environment builds trust between medical providers and their patients. Establishing rapport as an HRO is essential for the success of your team and those they care for.
Successful HROs have buy-in from every member of the team. Attention to detail, diligent followup on issues and consistent teamwork are just a few of the keys to success. But what truly makes an HRO? There are five key traits of a successful HRO.1
When these five traits are woven into organizational culture and practices, your health care facility will be on the fast track to becoming an HRO. But how do you get there? Becoming an HRO takes commitment to a wide variety of strategies and frameworks, but it is attainable for your organization.
Focusing your efforts on the most effective frameworks and implementation strategies can reduce wasted time and resources.
An article published in the September 2020 issue of Journal of Patient Safety, “Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review,” sought to synthesize all the HRO frameworks, metrics, and implementation effects to help inform health systems’ efforts toward becoming HROs. The authors reviewed bibliographic databases from 2010 to 2019, identifying 23 key articles detailing 8 different frameworks.
Their analysis revealed multiple notable findings about 9 different healthcare facilities who implemented HRO initiatives:
The authors pinpointed 5 key strategies common across the frameworks identified by their research:
Of the 8 frameworks analyzed, 2 stood out because they “involved extensive stakeholder involvement in their development and were the most comprehensive, broadly applicable, and sufficiently detailed to inform implementation.”7
Truman VA Medical Center in Columbia, Missouri worked for three years, beginning in 2016, to become a HRO. They improved patient outcomes, increased error reporting, and their process has since been developed into a list of 10 essential strategies for other organizations who want to replicate their results.
“The primary benefit of improving patient safety culture is to improve the transparency in reporting patient safety events, the heightened sophistication for examining the root cause of events that occur, the creation of meaningful action plans to mitigate or prevent such risk in the future, and an annual analysis of processes for standardization associated with ongoing training and repeated cycles for continuous improvement.”3
The 10 strategies are:3
Ten strategies may seem like a lot to put into practice. But tackling them one at a time will put your organization on the path to success. And in reality, “there is no recipe for transforming an organization into an HRO. Put another way, there is no easy path to achieving safe and reliable performance.”4
The steps to implementing strategies and a framework that move your organization in the right direction require leadership buy-in as they commit to the goal of zero patient harm.5 Get leaders on board by demonstrating how much profit can be saved by preventing a certain number of different types of adverse events. The Patient Safety ROI Calculator can help you evaluate the financial impact of various initiatives, down to the dollar.
The entire organization must also support a culture of safety — with “accountability, teamwork and communication”5 as essential elements of this support.
As your organization implements the 10 strategies listed above, it’s crucial to monitor growth by tracking various metrics and utilizing several measurement tools. Building and using data systems to measure progress helps develop solutions to problems at hand.5 Your organization can gauge success by gathering baseline metrics before beginning any HRO-related initiatives, and then measure progress throughout the following months and years.
There are several ways to measure change, including assessments and surveys. Maintaining a constant awareness of progress (or lack thereof) can help promote a culture of safety. No matter what tools you choose, consistency is key. Consider the following tools.
The Joint Commission’s Oro 2.0 High Reliability Assessment Tool5
Oro 2.0 is an online organizational assessment for executive leadership teams that identifies your organization’s current high reliability maturity level. The assessment helps senior leaders understand where they stand and paves a path towards zero harm.
Culture of Safety Self-Assessment Survey and Automated Analytics Report Tool8
The American College of Healthcare Executives also developed a self-assessment tool for leadership teams to assist organizations in their quest to develop a culture of safety. The survey is organized into six leadership domains: (1) Establish a compelling vision; (2) Build trust, respect, and inclusion; (3) Select, develop, and engage your Board; (4) Prioritize safety in the selection and development of leaders; (5) Lead and reward a just culture; and (6) Establish organizational behavior expectations. ADN packaged this self-assessment in an easy-to-use survey your organization can use as well as built an Analytics Report that is automatically generated as you receive survey responses.
AHRQ Patient Safety Culture (SOPS) Survey5
Providers and other staff can assess patient safety culture in their organization using this survey. Consider using a combination of an annual or biennial survey alongside a more frequent mini-culture survey. ADN offers an easy-to-use, HIPAA-compliant survey and a comprehensive reports package.
Mini Patient Safety Culture “Pulse Check” Survey and Automated Analytics Report Tool3
This 15-question patient safety culture survey developed by the Veterans Health Administration (VHA) National Center for Patient Safety can be used in between your annual or biennial AHRQ SOPS Survey to provide a pulse check on your progress.
Outcomes for Mortality and Complication Rates
Continuous measurement and evaluation of outcome measures are integral to any initiative, including comparisons to baseline performance to determine if improvements are made and whether headway is attributable to the newly implemented strategies. In-hospital Mortality and Complication rates are commonly-used, nationally-prioritized outcome measures to help assess the impact on the quality and safety of care.
Number of Patient Safety Events Reported3
Rather than a goal of less events reported, look for an increase in reporting that represents an improvement in communication and culture surrounding patient safety awareness. The Good Catch / Near Miss Campaign Toolkit can help your organization meet goals in this area.
Serious Safety Event Rate (SSER)3
Track adverse patient safety events involving severe harm or death. This rate should decrease due to events being caught before they occur, thus contributing to the goal of increasing the number of patient safety events reported. However, literature does suggest that if your facility already has a low SSER, this metric may be a less accurate indicator of HRO progress, meaning your facility’s patient safety may be improving without any meaningful movement seen in the SSER — all the more reason to be tracking multiple data points to measure progress.
High-reliability teams are committed to being mindfully attentive and actionable toward preventing errors and increasing safety.6 Through tracking the metrics above and taking steps to work toward each of the strategies outlined in this article, your organization will be on the path to becoming an HRO.
For more than 25 years, American Data Network (ADN), which is also the parent company to its Patient Safety Organization (ADNPSO), has worked with large data sets from various sources, aggregating and mining data to identify patterns, trends, and priorities within the clinical, financial, quality and patient safety arenas. ADN developed the Quality Assurance Communication (QAC) application, with which hospitals, clinics, rehabs, and other providers record and manage patient safety events. By entering events into ADN’s QAC application and submitting them to ADNPSO, information is federally protected and thereby privileged and confidential. These protections provide a safe harbor to learn from mistakes and improve patient safety.
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What the HRO Trait “Preoccupation With Failure” Looks Like in Practice [+...