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A High-Reliability Organization Framework for Health Care: A Multiyear Implementation Strategy and Associated
Gary L Sculli1, Robin Pendley-Louis1, Julia Neily1
1From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan.
Journal of Patient Safety
|October 12, 2020
Summary
The High-Reliability Hospital (HRH) model improved patient safety culture and reporting at Truman VA, leading to better quality outcomes. This framework is now being expanded to more VHA sites.
Area of Science:
- Healthcare quality improvement
- Patient safety research
- Organizational safety frameworks
Background:
- Implementing High-Reliability Organization (HRO) principles in healthcare presents challenges, with no established framework or clear impact data.
- The Veterans Health Administration (VHA) sought to address this by developing and testing a model for HRO adoption.
Purpose of the Study:
- To evaluate the effectiveness of the High-Reliability Hospital (HRH) model for HRO implementation in a healthcare setting.
- To assess the impact of the HRH model on patient safety culture, event reporting, and quality outcomes.
Main Methods:
- The VHA National Center for Patient Safety developed the HRH model, piloted at Truman VA Medical Center over three years (2016-2018).
- Intervention components included patient safety assessments, culture surveys, root cause analysis training, leadership walk-arounds, and process standardization.
- Impact was measured using patient safety culture surveys, event reporting data, standardized mortality rates, and complication rates.
Main Results:
- Truman VA demonstrated significant improvements in patient safety culture and event reporting compared to all VHA facilities (P < 0.001).
- Low-harm patient safety event reporting increased significantly (P < 0.001), while the serious safety event rate remained unchanged.
- Standardized mortality and complication rates at Truman VA showed immediate and sustained improvement compared to All VHA (P < 0.001 and P < 0.020, respectively).
Conclusions:
- The High-Reliability Hospital (HRH) model is an effective framework for implementing High-Reliability Organization principles in healthcare.
- The HRH model led to improved patient safety culture and reporting, with positive impacts on quality measures.
- Further research is needed to fully understand the HRH model's effect on serious safety events and quality outcomes.
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