High Reliability–Where Does It Fit In a Medical School Curriculum?

Articles on high reliability thinking continue to accumulate in healthcare journals…and for good reason. Research on high reliability organizations such as aviation and nuclear energy offer useful strategies and tools that have been shown to reduce risk in their environments, while providing hope for other high-risk industries such as healthcare. These studies reveal a number of common factors that help organizations achieve excellence. Creation of a just culture, leadership support, and a constant vigilance for kinks in the workflow that could lead to disaster are just three common themes that permeate the literature.

Like many aspects of safety science, high reliability education should be included in all patient safety curriculum, be it for students just starting a health science education, or for experienced caregivers as part of continuing education programs.  High reliability thinking is becoming the cultural foundation for many health systems across the country, and more healthcare organizations need to add high reliability knowledge, skills and assessment into their educational offerings.

An excellent resource that can be used for teaching high reliability concepts is an April 2011, Health Affairs article by Mark Chassin, the president of the Joint Commission, and Jerod Loeb, the executive vice president for healthcare quality evaluation at the Joint Commission entitled, The Ongoing Quality Improvement Journey: Next Stop, High Reliability. The authors suggest three interdependent and critical changes that must occur for an organizational culture shift to one of high reliability. These three changes are: (a) leadership commitment  (b) implementation of a safety culture that supports high reliability; and (c) tools of “robust process improvement” (e.g. Six Sigma, lean management) must be adopted.

Of particular educational value in the article is the discussion on collective mindfulness. It is an important concept I always share with my students – both at the medical school level, as well as with students in the Masters in Patient Safety Leadership program at UIC when our research and discovery is focused on high reliability thinking. Originally coined by Karl Weick and Kathleen Sutcliffe, and restated in the Chassin/Loeb article, collective mindfulness means “that everyone who works in these organizations, both individually and together, is acutely aware that even small failures in safety protocols or processes can lead to catastrophic adverse outcomes”. In other words, everyone always functions with an underlying uneasiness…a sense that things are just not right…as opposed to a feeling that nothing bad could happen.

As we move into a new era of healthcare, health systems that achieve the “Triple Aim” and provide the highest quality of care at the most affordable cost will be the ones who prevail. Arming health science students with the skills they will need to be successful given the changing requirements of healthcare seems only logical. But who is teaching these skills today? And better yet, when will students be required to have a working knowledge of, and demonstrate competence in, what it means to operate within high reliability organizations and work in interdisciplinary teams of excellence? Please comment and share programs you know that have started to incorporate high reliability training into their curriculum.


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