High reliability organizations: Delivering on our promise of excellence

Performing like a high reliability organization to deliver exceptional patient care

As we recognize Patient Safety Awareness Week (March 11-17), SSM Health highlights the importance of fostering an always safe culture for our patients and employees. 

One of the first stories I always shared with my public health students at Saint Louis University was that of Hungarian physician Ignaz Semmelweis, a true patient safety pioneer. After observing high mortality rates associated with puerperal fever—commonly known as childbed fever—Semmelweis began searching for a solution.

It was after he witnessed the death of a friend and fellow physician from sepsis that Semmelweis drew the association between the spread of infection and unwashed hands. As a result, Semmelweis introduced handwashing and sterilization standards at the General Hospital in Vienna in 1846. The result: a dramatic reduction in the rate of childbed fever and deaths from childbirth complications.

Like so many visionaries, though, Semmelweis’ revolutionary safety standard was widely met with resistance, and its life-saving impact not fully realized until years after his death.

Semmelweis’ story is not just an anecdote on hand hygiene, but also a broader testament to the importance of creating high reliability health care organizations (HROs). Simply put, HROs are organizations that operate in complex environments while consistently avoiding or minimizing serious accidents or catastrophic failures. Common examples of high reliability organizations include commercial airlines, nuclear power plants, and the military, and they all share key characteristics:
  • Preoccupation with failure: People in an HRO actively think about the potential for failure and use near-misses as opportunities to improve current systems and processes.
  • Sensitivity to operations: Stakeholders in HROs remain aware of the complex systems in which they work so they can quickly identify problems in processes that could lead to potential errors.
  • Reluctance to simplify issues of risk: Rather than relying on surface explanations, people in HROs seek underlying causes of successes and failures in their environment.
  • Deference to expertise: HROs recognize the knowledge available from each person in an environment and defer to the person with the most knowledge relevant to the issue they’re confronting.
  • Commitment to resilience: People in HROs prepare for unpredictable system failures and practice how to respond to unexpected challenges.
Thanks to Semmelweis’ preoccupation with failure, sensitivity to operations, and reluctance to simplify issues of risk, he identified one of the most important infection prevention tools in modern public health. Who knows how many more lives Semmelweis’ standards could have saved in his lifetime if the HRO model existed and the General Hospital upheld deference to expertise and commitment to resilience.

In today’s changing health care landscape, being a high reliability organization is essential to providing exceptional patient care and maintaining competitive advantage. Thanks to public reporting from organizations like the Centers for Medicare and Medicaid Services (CMS), our patients are more educated than ever before on our ability to deliver on the promises of safety and quality.

Like any organizational model, high reliability organizations are only as successful as the actions they repeatedly take. Here are a few ways health care organizations can start thinking and performing like an HRO:
  • Actively be on the lookout for potential failures in every environment and proactively discuss and identify how to mitigate those failures.
  • Communicate an organization’s key data. Share important clinical and operational information early and often to foster shared attentiveness.
  • Understand that everyone has a role to play in ensuring patient safety, and leverage the knowledge of all parties involved in patient care.
  • Practice how to respond quickly and efficiently to unexpected, challenging situations to help prepare for potential safety events.
  • Look to HROs outside the health care industry for inspiration on strategies and tactics that may work in a health care environment.
As Semmelweis’ journey to patient safety proves, creating a resilient and reliable HRO culture is an ever-evolving process that requires both personal and organizational commitment at every level. Now, more than ever, it’s time for health care organizations to go all-in to build upon strong patient safety foundations to deliver on our promise of excellence. 

As Chief Quality Officer, Alexander Garza, MD, is responsible for quality, patient safety and clinical analytics, and for positioning SSM Health as a quality and patient safety leader nationally and internationally.

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