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High reliability on the frontline

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"Consistently high levels of safety and quality over time and across all health care services and settings"—this is the definition of high reliability in health care used by The Joint Commission.

Although the concept of high reliability in health care is not new for health care executives, high reliability is "still fairly foreign to frontline staff," says Coleen Smith, RN, MBA, CPHQ, High Reliability Initiatives director for the Joint Commission Center for Transforming Healthcare. "The executive level is where the driving force for high reliability needs to start, but it’s important that frontline staff understand why the conversations are occurring."

Smith says all perioperative nurses can benefit from thinking about high reliability in their daily practice. She says nurses may describe high reliability as actions that result in less patient injury, something nurses do every day, for example, when they follow standardized practices to reduce the risk of pressure ulcers or wrong site surgery.

"High reliability also involves preoccupation with failure—always thinking about the next thing to go wrong," she stresses. "In nursing school, we are trained to believe we can’t make mistakes if we have the knowledge needed to do our job, but this isn’t realistic—we are human and mistakes happen. High reliability aims to prevent the opportunity for those mistakes to occur and lead to patient harm."

Learning from others
In the most comprehensive effort so far to expand high reliability discussion into implementation, the Joint Commission Center for Transforming Healthcare and the South Carolina Hospital Association are beginning the South Carolina Safe Care Commitment. This multi-year engagement involves 21 hospitals across seven health systems in South Carolina working collaboratively to survey, analyze and start addressing the cultural and operational deficiencies that undermine a hospital’s ability to provide care that is consistently excellent and consistently safe.

Here’s a snapshot at what the teams will be doing over the next year to move toward high reliability:

This month, senior leaders from the 21 participating South Carolina hospitals are beginning to use a high reliability self-assessment tool created by the Joint Commission Center for Transforming Healthcare to help them understand their unique challenges and strengths in key areas that support and promote high reliability, including:

  • leadership
  • safety culture
  • process improvement
This tool asks senior leaders specific questions regarding topics such as, physician involvement in quality improvement activities, processes for internal and external quality measure reporting, and actions following close calls.

In May, each leader from these 21 hospitals will come together with Smith and other Center for Transforming Healthcare experts to discuss the results of this self-assessment process. Based on data collected, hospital leaders will identify individual areas for targeted improvement toward high reliability.

Quality Improvement
Later this summer, Commitment leaders will begin working with their hospital teams to implement Robust Process Improvement™ tools and methods to address the specific challenges identified in their surveys. Once changes are applied, each facility will continue to observe and measure the success of their quality improvement toward high reliability

The work of this Commitment is complex and not part of a project with a beginning and end date, Smith notes. "It’s an ongoing engagement to address what needs to change in health care to provide the consistently high level of care that every patient deserves."

Find ways to improve high reliability in your practice setting
Smith expects initial findings from Commitment participants to be shared over the next year. She also encourages health care professionals across the country to assess barriers that stand in the way of high reliability by using a safety culture survey, such as the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture.

Additional Resources

Follow the work of the South Carolina Safe Care Commitment and learn more about high reliability in health care by accessing The Joint Commission’s High Reliability Resource Center.

Guidelines for Perioperative Practice


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