Running head: HIGH RELIABILITY ORGANIZATIONS ASSIGNMENT 1
High Reliability Organizations Assignment Mariah Delaire HCA 622 February 20, 2016 Professor Courtney Johnson
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High Reliability Organizations (HROs) are organizations that strive to achieve zero defects by using systems and processes that consistently accomplish goals, and avoid potential consequential and catastrophic errors. HROs are fairly new to the healthcare industry, but were first embraced by organizations whose failures led to catastrophe, such as airplane crashes, nuclear reactor meltdowns, and other disasters (Hines, Luna, & Lofthus, 2008). These types of industries felt it necessary to identify weaknesses in their operations, and respond strongly so disasters could be maintained and avoided. This paper focuses on determining what a high reliability organization is, and elaborating on how organizations can achieve high reliability status. To better explain how a HRO is formed, Johns Hopkins Health System is used as an example due to their Top Performer status granted to them by The Joint Commission.
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High Reliability Organizations Assignment Characteristics of HROs Common characteristics that High Reliability Organizations hold is that they prioritize safety and performance while having shared goals across the organization. They also establish a culture of reliability that is both centralized and decentralized throughout operations, allowing decisions to extend outside of executive leadership and towards lower ranking employees (Chassin & Loeb, 2013). HROs also use “trial and error” learning processes to help change for the better if accidents, incidents, and near misses occur, allowing members to better adjust to these issues (Daved Van Stralen, 2013). It is essential that healthcare organizations ensure reliability in order to provide the best quality care to their patients, and prevent medical errors and inefficiencies. What impact do HROs have on the healthcare industry? High reliability organizations have many positive effects on the current health care industry in many ways. HROs promote an environment of “collective mindfulness” where employees constantly look and report small problems or any unsafe conditions before they become a risk to the organization (Chassin & Loeb, 2013). Due to the fast acting nature of HRO employees, organizations rarely have accidents that lead to catastrophic events. They also utilize any information gained from identified errors or close calls, and can analyze the events to pin point specific weaknesses in safety and procedures to help reduce future risk (Chassin & Loeb, 2013). Medical errors are a major defect hospitals try and avoid, but without systems and protocols in place, there are no real ways of avoiding them. High reliability models reduce medical errors and continuously improve the quality of care they give to patients. The advances in health information technology (HIT) have helped contribute to high reliability as well. HIT has allowed hospitals to
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better monitor their systems of care, medication dispending, and the amount of system waste (Hines, Luna, & Lofthus, 2008). Along with reducing medical errors and the use of HIT, high reliability demands total quality management and continuous quality improvement with the use of methodologies such as Six Sigma and Lean Thinking (Hines, et al, 2008). Without continuously trying to achieve zero defects and improve quality, hospitals would fail to meet the needs of their patients. Johns Hopkins Healthcare System: A High Reliability Organization Johns Hopkins Medicine (JHM) is a healthcare system that comprises of six academic and community hospitals, four suburban health care and surgery centers, and more than 30 primary health care outpatient clinics (Johns Hopkins Health System, 2016). Three hospitals in the Johns Hopkins Healthcare System have been named Top Performer by The Joint Commission for key quality measures. Hospitals who consistently follow best practices for treating people who required surgery, heart attacks, heart failure, stroke, pneumonia, and other serious conditions can be recognized as a Top Performer (Johns Hopkins Medicine, 2016). What Makes Johns Hopkins Highly Reliable? In 2011, Johns Hopkins Health System created the Armstrong Institute for Patient Safety and Quality. The goal of this institute was to accommodate the process of improving quality and safety, advancing the science of improvement, implement improvement programs and support systems, and create a culture that supports learning and accountability (Pronovost, Demski, & Callender, 2013). An extended goal of the Armstrong Institute is to partner with patients and their loved ones to eliminate preventable harm, improve patient outcomes and experience, and reduce health care related waste (Hines, 2008). In order to be named a Top Performer by the Joint Commission, at least 95% of
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patients must receive the recommended therapies for the accountability measure. To achieve this, JHM set a goal of 96% to ensure patients received the recommended care. The Armstrong Institute created a conceptual model to address any challenges that may accompany quality and safety initiatives. This model included clarifying and communicating goals that measure across all levels of the organization, building capacity using the Lean Sigma methodology, education, and clinical communities, report and ensure accountability for performance, and develop a sustainability process (Pronovost, Demski, 2013). Johns Hopkins Hospital (JHH) ensured patients always received the best care by forming 40 multidisciplinary groups across the health system. Each group was made up of a faculty member and a quality improvement coach from the Armstrong Institute. The faculty members were experts in patient safety and the coaches trained in Six Sigma, allowing for more efficient processes to occur (JHM, 2016). The use of the conceptual model assisted Johns Hopkins Hospital to significantly improve its performance on the accountability measure, which allowed them to meet the specific criteria for Top Performer. The goals and initiatives that Johns Hopkins Health System set allowed for quality and overall performance to improve, while creating a system with less inefficacies and better patient outcomes. Conclusion The implementation of high reliability processes in organizations is essential to providing efficient and quality care with little defects. Today’s health care system focuses more on the quality of care patients are receiving, and in order to better accommodate their needs, hospitals need to focus on eliminating defects. Johns Hopkins is an exemplary example of how hospitals can achieve this status. If more organizations follow their model, then we will live in a system with little health related errors and high quality care for everyone.
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References Chassin, M. R., & Loeb, J. M. (2013). High Reliaibilty Healthcare: Getting Here from There. Oakbrook Terrace, IL: The Joint Commission. Daved Van Stralen, M. (2013). Models of HRO. Retrieved from High Reliability Organizing: http://highreliability.org/HighReliabilityOrganizations Hines, S., Luna, K., & Lofthus, J. (2008). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. Rockville, MD: Agency for Healthcare Research and Quality. Johns Hopkins Health System. (2016). The Johns Hopkins Hospital and Health System. Retrieved from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/jhhhs.html Johns Hopkins Medicine. (2016). Three Johns Hopkins Medicine Hospitals Named “Top Performers” in Quality and Safety. Retrieved from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/news/stories/johns_hopkins_medicine_hospitals_named _top_performers_quality_safety.html Pronovost, P. J., Demski, R., & Callender, T. (2013). Demonstrating High Reliability on Accountability Measures at The Johns Hopkins Hospital. The Joint Commission Journal on Quality and Patient Safety, 531544.
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Ransom, E. R., Joshi, M. S., Nash, D. B., & Ransom, S. B. (2008). Variation in Medical Practice and Implications for Quality. In The Healthcare Quality Book; Second Edition (pp. 43 59). Chicago: The Foundation of the American College of Healthcare Executives.
