Seeking High Reliability

Red_Jets_Formation_sxc418932_8877We have written extensively on ETY about the value of embedding the principles of high reliability seeking organizations into health systems. We have been on our own high reliability seeking journey at MedStar Health, partnering with Healthcare Performance Improvement (HPI), a leading high reliability consulting group. I have come to know the tenets of high reliability are excellent ways to keep our patients and care providers safe.

This past July we invited Denise Murphy, RN and VP Quality & Safety from MainLine Health, to speak at our Quarterly Quality, Safety & Risk Management retreat. Denise shared firsthand what a health system can accomplish once they embrace a high reliability culture. She noted that 100% of MainLine caregivers and employees went through high reliability training – no exceptions – which speaks to the important roles everyone in an organization plays in striving for zero patient harm. And MainLine Health has started seeing tangible success from all their hard work.

To move towards high reliability, patient safety must trump everything else. High reliability organizations always put safety at the center of everything they do. As James M. Anderson, Past President & CEO of Cincinnati Children’s Hospital and Medical Center said in their hospital’s quest for high reliability:

“There is no priority higher than patient safety. If there is a conflict between safe practice and speed, efficiency or volume, then safety wins – hands down.”

High Reliability leaders are not only vocal but they are also very visible. They “walk the talk” by role-modeling high reliability characteristics, start all their meetings with safety stories, and engage their associates in weekly Leadership Safety Rounds.

Like Mainline Health, MedStar Health has already interviewed over 500 leaders and associates from across our system to identify which high reliability tools and techniques should be implemented. Steve Evans, Executive Vice President for Medical Affairs for the MedStar Health system, started off our last High Reliability meeting by saying “We want to be able to tell our patients, friends and families this is the place to be. It’s the safest organization to receive care.” Steve cited “unconscious competence” as the greatest risk to any organization. We need to change our thinking from “I’ve done this procedure or task many times – everything will go well”, to being mindful and always asking others “what could possibly go wrong today”. Healthcare providers in high reliability organizations acknowledge their own vulnerabilities, take nothing for granted, and are quick to adopt new tools or techniques shown to reduce patient risk.

Airplane pilots understand human vulnerability – the best pilots can make a mistake. It is why pilots would never disregard the numerous risk reduction tools implemented in aviation that help trap human errors before they lead to harm…things like pre-flight briefings, maneuver read backs, and checklists. The best caregivers also can make a mistake. Physicians, nurses, pharmacists and others who understand that anyone can make an error when the “holes in the Swiss cheese” align are the caregivers I want taking care of me or my loved ones.


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