At Cincinnati Children’s, we take a comprehensive, system approach to safety that involves several interdependent areas we believe are key to achieving our goals.
Becoming a High Reliability Organization (HRO)
The theory of high reliability has come to healthcare from naval aviation and the nuclear power industry. At Cincinnati Children’s, we believe that becoming an HRO will not only make us a safer organization, but also make us better at everything we do. Learn more about the characteristics of an HRO.
Focusing on Outcomes of Harm
We closely monitor the quality and safety of our care so that we can continually improve; we believe that transparently sharing our results drives us toward achieving our goals. Measurement of our safety outcomes allows us to understand how we are performing relative to our goals. We work to understand the reasons for gaps between our performance and goals, and use this knowledge to improve the methods and processes of the care we deliver.
Detecting and Measuring Harm
We detect and measure harm through a variety of methods including our safety reporting system, automated trigger tools, unit and department huddles and by cause analysis. It is critical to our work because it is how we identify both what we need to work on and whether our work is having a beneficial impact. It is the responsibility of everyone to look for harm − even near misses where no harm takes place − because this helps develop our high reliability microsystems.
- Root cause analysis of serious safety events (SSEs) and precursor safety events allows us to understand how we can change the system to make it safer both for patients and those who deliver care. Many of our major safety initiatives − our daily operational brief, situational awareness work, and rounding and huddling methods − address problems identified as a result of analyzing events of harm.
- Common cause analysis breaks down causes of harm and resulting information into buckets that allow us to identify themes and trends that we need to work on as an institution and predict where harm will occur in the future.
- Detection. To increase our ability to detect harm, we use multiple tools: promotion of a culture of open-ended conversation and reporting, implementation of a safety / incident reporting system, a daily operational brief and unit-based huddles. We also use trigger tools (for example, automated tools to detect events that can be analyzed to design safer practices).
- We track and trend all safety reports and implement improvement teams where needed, determine which triggers give us the highest predictive value for detecting possible harm, measure our ability to detect unexpected outcomes from the last 24 hours, and conduct analysis of our safety reporting to identify and correct trends that result in harm or seem to predict possible sources of harm.
Supporting a Culture of Safety
Supporting a culture of safety is critical to achieving our safety goals. A robust culture of safety allows us to implement multiple tactical strategies and ensures the success of our efforts. Our leaders influence staff and their values and beliefs, which help drive our safety outcomes. Some examples of our efforts:
- Partner with patients and families on safety
- Maintain a safety coach program
- Mandatory error prevention training using behavioral-based expectations for all staff
- Flatten hierarchies in high-risk areas
- Simulation training
- Administer, analyze and take actions based on our annual AHRQ patient safety survey to improve our results and work to keep patients and employees safe
Building High-Reliability Microsystems
Key to our efforts is building high-reliability microsystems that support innovation and improvements on the unit level:
- Share nurse / physician leadership within microsystems
- Track unit level outcomes
- Promote unit-level improvement / innovation
- Develop a learning system across microsystems
- Create a locus of prioritization “catchball”
- Identify key processes and achieve reliability on all of them
Demonstrating Improvement Capability
Having the capability to learn and improve with all leaders trained in quality-improvement science is an important aspect of our progress. Learn more about our education programs.