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Catching the HRO Wave: Marching Towards “Zero Harm to Patients”

Submitted By: Dr. Bahadir Inozu

After seeing the benefits of becoming a High Reliability Organization (HRO) in other industries, Military Healthcare System (MHS) is transforming into an HRO, as mandated following a  Secretary of Defense ordered review of safety, access, and quality in 2014.  This review stated that, “The foundation for improving performance in the MHS rests on combining the concepts of an integrated health care system with those of high reliability organizations. The principles of a high reliability organization are operationalized through leadership engagement, a culture of quality and safety, robust process improvement,” according to the review.

HROs are able to reduce errors through culture changes and technology while working in an inherently high-stress, high-tempo environment. In collaboration with George Mason University, NOVACES sponsored a one-day workshop on “Developing a Culture of Safety in Health Care: The Benefits of Becoming a High Reliability Organization” on June 24, 2015 in Fairfax, Virginia to raise awareness about the benefits of HRO to encourage other Healthcare Systems to become HRO’s.

The workshop started with a focus on “Why Change?” and it provided a basis for understanding how adopting HRO operational practices can help create a culture of safety, reduce the number of errors, and meet safety, quality, and efficiency goals.

Why should hospitals become High Reliability Organizations?

It is estimated that as many as as many as 400,000 preventable deaths occur every year in the United States in civilian hospitals, according to an article published in the Journal of Patient Safety in 2013. Indeed, almost everyone knows at least one person who was harmed due to preventable mistakes at hospitals. Hence, there appears to be a consensus to increase the patient safety levels to new heights.

The Goal of becoming an HRO is “zero preventable harm in high risk operations.” Other high risk industries have achieved this goal to a certain extent such as the Aerospace, Civil Aviation, Nuclear Power Industries as well as Nuclear Submarines and Aircraft Carriers. Transformation to HROs is long overdue for the healthcare industry.

“If done properly, the quality of care will markedly improve throughout the transformation process. HRO is not just another initiative, it’s a commitment to your patients that’s too important not to make,” said Spence Byrum, CEO of HRS Consulting, Inc. He saw its amazing impact in aviation, as a former United States Coast Guard pilot.  There is a pending rule that will further reduce reimbursement for hospitals not proficient in an “all hazards” approach to disaster preparedness. “Reimbursements will go down if hospitals do not take an all hazards approach,” Byrum warned.

“You have a plan. Then life will let you know whether your plan is any good!” said W. Earl Carnes, who served as a Senior Advisor of DOE for High Reliability & Liaison with the Institute of Nuclear Power Operations (INPO).  He added “It is hard to see what HRO’s do. Most organizations focus on tools, but attempts to adopt practices without understanding concepts, models and principles routinely meet with failure. What is missing is how they think, how they work together, what they view as important. Perhaps the best way to learn is to listen to their stories, to hear about both what they do and how they think.”

“People who understand this approach best are those who have been vulnerable… People who have been at risk of dying” said Dr. Daved van Stralen, who pioneered the application of HRO principles in healthcare. He added, “There is a cross over, a threshold that changes the way they think. It is hard to translate that to other people.”

“Your life is a lot safer because of HROs” said Mark A. Crafton, Executive Director of State and External Relations at The Joint Commission. He gave examples from other his risk industries including aviation, banking and theme parks. Universal Studios in Orlando is a good benchmark, where the goal is to ensure safety of staff and visitors. Entire park and each stunt are under constant video surveillance and safety personnel intervene immediately when a safety risk is detected.

Some of the leading hospitals already started their journey to HRO transformation include Atlantic Health, Barnes-Jewish, Baylor, Cedars-Sinai, Cleveland Clinic, Exempla, Fairview, Floyd Medical Center, Froedtert, Intermountain, Johns Hopkins, Kaiser-Permanente, Mayo Clinic, Memorial Hermann, New York-Presbyterian, North Shore-LIJ, Northwestern, OSF, Partners HealthCare, Sharp Healthcare, Stanford Hospital, Texas Health Resources, Trinity Health, VA Healthcare System-CT, Virtua, Wake Forest Baptist, Wentworth-Douglass and MedStar Health. And the list is growing fast with the addition of the Military Health System.

The workshop participants also discussed “What blocks us from reaching the HRO goal? What are the constraints and how to break them? Which information will we need?” In the next article we will discuss these and “What to Change” to become an HRO.

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