Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post...

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Organizational Behavior in Healthcare

Background:

• The Veterans Health Administration (VHA) implemented a High-Reliability Organization (HRO) framework across its facilities.
• This initiative aimed to enhance patient safety and quality within the integrated health system.

Purpose of the Study:

• To evaluate the outcomes of an enterprise-wide High-Reliability Organization (HRO) framework implementation.
• To assess changes in patient safety culture and reporting data within VHA facilities.

Main Methods:

• A quasi-experimental design using pre-post data from 139 VHA facilities (2019-2023).
• Data sources included the Patient Safety Culture (PSC) survey and Joint Patient Safety Reporting system.
• Interventions involved training, coaching, assessments, and experiential learning, with staggered implementation across three cohorts.

Main Results:

• Broad positive trends in PSC scores were observed across all facilities.
• Significant improvements noted in PSC Dimension 2 (Risk Identification and Just Culture) and Dimension 4 (Error Transparency and Risk Mitigation).
• Increased patient safety event and close call reporting, alongside a higher ratio of close calls to adverse events, particularly in Cohort 1.

Conclusions:

• The HRO framework implementation positively impacted patient safety culture and reporting within the VHA.
• Findings will guide future refinements of HRO principles in the VHA and inform similar large-scale quality improvement efforts in other health systems.