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Transforming Safety Culture: A Systemwide High Reliability Approach to Preventing Serious Harm in Healthcare
Mallory A Koshiol1, Juliana Aadland1, Julie M Lauria1
1Allina Health Safety, Quality, and Experience, Minneapolis, MN.
Summary
Implementing a systemwide high-reliability organization (HRO) approach significantly reduced serious safety events by 71% in hospitals. This initiative also improved safety culture, demonstrating lasting reductions in preventable harm.
Area of Science:
- Healthcare Management
- Patient Safety
- Organizational Behavior
Background:
- Preventable medical error is a significant cause of mortality in the U.S.
- Existing high-reliability organization (HRO) efforts often lack integration across healthcare systems.
- Gaps exist in integrating HRO principles across culture, learning systems, and ambulatory care settings.
Purpose of the Study:
- To evaluate the impact of a systemwide high-reliability organization (HRO) improvement initiative on serious safety events (SSEs) and safety culture.
- To assess the effectiveness of integrated HRO strategies including leadership development, unified reporting, and safety huddles.
- To determine if a unified HRO approach can reduce preventable harm and foster cultural transformation within a large health system.
Main Methods:
- Retrospective observational study from January 2019 to June 2025 across 12 hospitals and over 90 ambulatory clinics.
- Intervention included leadership development, a unified safety reporting system, tiered safety huddles, and structured root cause analysis feedback.
- Safety culture assessed via Agency for Healthcare Research and Quality surveys (2021, 2024); SSEs standardized as serious safety event reports (SSERs) per 10,000 patient-days.
Main Results:
- Hospital SSERs demonstrated a significant decrease of 71% (P < 0.001 for trend).
- Ambulatory SSERs showed a non-significant increase (P = 0.356 for trend) attributed to enhanced harm detection.
- Safety culture composite scores improved in 11 of 13 domains, notably in leadership support and communication.
Conclusions:
- A systemwide, unified HRO approach integrating standard work, leadership alignment, and proactive design leads to significant reductions in preventable harm.
- The initiative successfully drove cultural transformation and improved safety reporting and leadership engagement.
- Holistic HRO implementation is effective in achieving lasting safety improvements and cultural change in healthcare settings.
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