Key to OB safety effort: high-reliability concepts

Ascension Health, the nonprofit health system based in St. Louis, MO, already had made progress in reducing injuries to newborns and the associated management of risk exposures before launching the Excellence in Obstetrics program, says Christine K. McCoy, JD, the system's vice president of risk management.

The improvements were made through pro-active strategies including more open communication with patients and families, she says. Nonetheless, Ascension leaders realized that an opportunity existed to learn more about ways to reduce injury and death for newborns and to share the knowledge of successful models with other healthcare providers, McCoy says. That led Ascension Health to choose obstetrics as the focus of its initial demonstration project in linking patient safety to medical malpractice reform using what the Agency for Healthcare Research and Quality (AHRQ) calls "high-reliability concepts." According to AHRQ, high-reliability organizations (HROs) are characterized by five defining elements of high-reliability:

• A preoccupation with failure — tracking small failures and near misses with a focus on predicting and eliminating catastrophes;

• A reluctance to simplify — an awareness that in a complex environment, a simplistic solution may not acknowledge the full range of opportunity for error or look deeply enough into the complex interactions and processes;

• Sensitivity to operations — recognizing that in an environment of frequent change, situational awareness is critical to recognize and address anomalies and potential errors;

• Resilience — the capability to quickly contain errors. It requires effective teamwork to adapt and respond quickly when setbacks occur;

• Deference to expertise — de-emphasizing hierarchy to get to the person most knowledgeable of the issue.

McCoy explains that because patient safety and medical liability are inextricably linked, Ascension Health's project is based on the concept that instituting the culture and procedures inherent in an HRO not only will improve patient safety, but also will reduce medical liability.