Cincinnati Children's Blog

Safety and quality in a high reliability organization

In this space recently, Dr. Steve (our safety officer, Steve Muething, MD) wrote about our patient safety journey. He did so by reminding us at the Tuesday morning Grand Rounds that we are not perfect, but that we’re making progress and we’re always trying to improve.
That’s something he and others try to engrain in all our employees. It’s not always easy. But the goal is to make sure every patient receives the best possible care every time. Not some of the time – all the time.
Safety is not a novel concept. In fact, in some industries, like the airlines or nuclear power generation, it is job one. For them, us and others in health care, it’s a quest to become a “high reliability organization.” It’s not just a name or a gimmick. It’s real. Like life and death.
At Grand Rounds, we learned about the five characteristics that make up the mindset of high reliability organizations. The characteristics are essential to achieve exceptionally low levels of defects. Without a constant state of “mindfulness,” an organization cannot create or sustain highly reliable systems.

The characteristics are:

  • Sensitivity to operations: we must recognize the complications of our systems, understand processes change and work quickly to overcome problems.
  • Reluctance to simplify: Healthcare is complex. The system can fail in ways we can’t imagine; and we can’t possibly be prepared for all the things that can go wrong.
  • Pre-occupation with failure/errors: We focus on predicting and eliminating disasters, not just reacting to to them.We consider “near misses” as opportunities to improve.
  • Deference to expertise: Doctors, nurses, parents and even the children themselves have knowledge. We can learn from all of them.
  • Resilience: We work to quickly contain errors, react in innovative ways and continue to serve patients despite “system” errors.

But enough from me. We only know what we know. There are lots of people you can learn from on this topic. One of our favorite web sites is the federal Agency for Healtcare Research and Quality.
We’re glad the country is focused on health care reform. When Congress settles on a health insurance plan that’s been the center of the debate for months, we look forward to moving the discussion to ways to change the outcome for all patients. We’re planning to be a part of that.


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