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Our goal is to be the safest hospital. Cincinnati Children’s 2015 strategic plan calls for the elimination of all serious patient harm and achievement of the lowest rates of employee injury by leveraging internal and external expertise toward becoming a high reliability organization (HRO) by June 30, 2015.
These plans represent a deepened understanding of what we must do to provide the best possible care for each child, be the leader in improving child health and create a safe environment for our patients and employees.
Learning from other industries provides opportunities to test best practice ideas in a healthcare setting. We have partnered with naval operations, an international technology and specialties materials company and university professionals to push the boundaries of what is possible in healthcare. This is a new and rich source of learning for Cincinnati Children’s.
Our journey toward becoming a high reliability organization focuses on improving reliability through better process design, building a culture of reliability and leveraging human factors by creating intuitive designs that help people do the right thing. Though our drive to become an HRO originated with safety, we have come to realize this work will improve our performance in everything we do.We’re also focusing on several principles of reliability science:
The theory of high reliability has come to healthcare from naval aviation and the nuclear power industry. The following are five key characteristics of an HRO, according to Weike and Sutcliffe:
Everyone is focused on errors and near-misses, learning from them and figuring out how to prevent them from happening again. Attention to detail is crucial. Finding and fixing problems is everyone’s responsibility and is encouraged and supported by leadership.
Requires constantly asking the “why” question and inviting others with diverse experience to express their opinions. The belief is that the more you’re immersed in something, the harder it is for you to objectively observe and question things that need questioning. Leverage new thinking to get the right answer!
An ongoing concern with the unexpected. Hallmark actions include closing loopholes in processes where there is potential for patient harm, maintaining situational awareness, developing teams that speak up and paying attention to the frontline – which in hospitals is primarily nurses, patient care attendants, techs and support staff.
The concept that things will go wrong that we can’t predict; mistakes will be made, and we will get into trouble. But we will quickly identify issues and have structures in place so we can immediately respond and minimize the harm. Errors won’t disable us.
Finding and using experts for the given problem in the given time. More specifically, it means recognizing that those closest to the frontline are the experts and empowering them to make decisions when a critical issue arises results in quicker mitigation of harm.
In HROs, senior leaders are conducting frequent walk-rounds to reinforce safety behaviors and find and fix critical safety issues. They’re also meeting in daily operational briefs where they look back to learn from failures and look forward to predict and lessen risk or harm.
Frontline leaders (for example, unit charge nurses) are rounding with staff every day, giving 5:1 positive to negative feedback, conducting daily huddles and modeling the expected safety behaviors. HRO leaders manage by anticipation and prediction rather than reaction. Frontline leaders are focused on predicting events in the next 24 hours and making real-time adjustments to keep patients, families, employees and visitors safe.
Having a housewide daily operational brief is a method utilized in high reliability organizations.
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