When they take the Hippocratic oath, doctors vow to “first, do no harm,” and some hospitals are taking that sentiment seriously. As with the aviation and nuclear power industries, which have zero tolerance for accidents, the hospitals seek to be “high-reliability” organizations that are obsessed with safety.
This quest requires a proactive approach, focused on anticipating and preventing problems and analyzing near-misses and accidents, says Coleen Smith, RN, MBA, CPHQ, director of high-reliability initiatives at the Joint Commission Center for Transforming Health Care.
Hospitals striving for high-reliability must commit to leadership engagement, robust process improvement (such as Six Sigma), and a blame-free culture of safety, Smith says. It is not a project, she says. “This is a way of life. This is how they will do business and care going forward,” she says.
The largest movement toward high reliability may be occurring in South Carolina, where the South Carolina Hospital Association teamed up with the Joint Commission to create the South Carolina Safe Care Commitment. So far, 26 of 67 acute care hospitals have joined the initiative, which begins with the Joint Commission High Reliability Self-assessment Tool and a safety culture survey.
Many hospitals have adopted daily safety huddles, brief meetings of top hospital administrators and managers that allow them to share information about potential problems or recent incidents. “You’re trying to mitigate anything you can think of that could possibly produce harm—before it happens,” says Lorri Gibbons, RN, BSN, CPHQ, vice president for quality and safety at the South Carolina Hospital Association.
For example, safety huddles may highlight the impediments caused by parking lot repaving or hospital construction, the potential confusion of two patients with the same name on a surgery schedule, and the possible security risk related to an agitated patient or family members.
High reliability at Memorial Hermann Healthcare System in Houston includes a specific focus on employee safety. Each of the 12 hospitals in the system has an employee safety champion, and the departments include employee safety in their daily or weekly huddles. The health system also tracks injury rates, with the goal of continuous improvement.
“If you’re working safely, you’re reducing patient safety hazards at the same time,” says Cory Worden, MS, CSHM, CSP, CHSP, REM, CESCO, manager of System Safety. “If we can show every time an employee moves a patient that they’re using the right [equipment], then that’s one less patient at risk for a fall.”
When accidents occur, root-cause analysis seeks ways to reduce existing hazards and prevent a recurrence, says Worden.
The Ebola outbreak in Dallas illustrated the principles of high reliability because any slip in safety measures could lead to dire consequences, he says. “Everybody realizes that hazard control and diligence to high-reliability procedures is really necessary,” he says.
High reliability is an all-encompassing effort. Hospital leadership must provide the necessary training, equipment and protocols, and employees must commit to following safe practices, Worden says. “Ultimately, you have safe behavior in a safe environment,”