(OAKBROOK TERRACE, Ill. – May 22, 2012) Day one of the Fifth International High Reliability Organizing Conference opened with a keynote address from Mark R. Chassin, M.D. FACP, M.P.P., M.P.H., president, The Joint Commission, on the topic of “High Reliability Healthcare: What’s Holding Us Back?” Chassin focused on the importance of achieving and maintaining consistently high levels of safety and quality over time. He explained how the framework that he and Jerod M. Loeb, Ph.D. executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission, presented in their article “The Ongoing Quality Improvement Journey:  Next Stop, High Reliability,” published April 7, 2011, in Health Affairs, can help organizations that need guidance on their quest to achieve high reliability. The article, Chassin noted, outlines three interdependent and equally critical changes that must take place for an organization to achieve high reliability: Leadership must commit to achieving the goal of zero major quality failures; the organization must fully implement all the principles and practices of a culture of safety; and the tools of robust process improvement must be utilized to their maximum potential to create, deploy, and maintain consistently excellent care processes.

Keynote panelists included:

• John Chessare, M.D., president and CEO, Greater Baltimore Medical Center HealthCare System, discussed his organization’s two-year journey towards high reliability and how they used the Health Affaires article framework presented by Dr. Chassin and Loeb as a model for their program. In his presentation, Chessare explained health care workers at his system were in pursuit of outstanding patient care, but the absence of rigor in the design of systems and the absence of a culture that would allow for collaboration to get measurable results were major impediments towards the new vision. Listen to Chessare discuss some of the challenges of moving his organization towards high reliability in a podcast available here.
• William Munier, M.D., MBA, director, Center for Quality Improved and Patient Safety, Agency for Healthcare Research and Quality, presented on how to maximize the effectiveness of high reliability in health care.  Munier spoke about performance improvement initiatives at AHRQ to support organizations on their journey to becoming high reliability organizations. The initiatives include a program to develop common formats for patient safety reporting with the aim of meeting the nation’s need for measurement as articulated by the Institute of Medicine and Office of the Inspector General. 
• Steve Kreiser, CDR (USN, Ret.), MBA, M.S.M., senior consultant, HealthCare Performance Improvement, gave an overview of the “Top 10 Healthcare High Reliability Organization Failures.” Kreiser, a Navy pilot, explained leadership tactics used in the Navy that translate to health care including accountability for behavior. Kreiser said he has witnessed pilots losing their wings for irresponsible behavior and stressed leaders and staff need to be held accountable for work practices. He explained organizations that provide clear expectations around safety and that hold workers accountable for adopting low-risk behaviors, and fix barriers that make it hard to comply with expectations have found great success in reducing preventable events of serious harm.

The plenary address was presented by:

• Daved van Stralen, M.D., F.A.A.P., Strategic Reliability, LLC, set forth the concept that high reliability can best be described as, and implemented through, the understanding and use of attitudes. He described how high reliability emerges from a basic modeling of attitudes toward reliability and five necessary and sufficient attitudes used to manage the unexpected. In addition, van Stralen went on to examine the other constellation of attitudes found in high reliable organizations, such as duty and empathy, and their impact. Listen to van Stralen discuss how certain behavioral attitudes can be reevaluated to help foster an environment of high reliability in health care in a podcast interview recorded shortly after his address.

The Joint Commission is hosting the conference May 21-23, at The Joint Commission Conference Center located in Oakbrook Terrace, Ill. The conference, organized by Strategic Reliability, LLC, features academics and HRO veterans from diverse industries who will share practical steps to help organizations move toward high reliability. To keep you updated on the conference happenings, The Joint Commission is providing daily updates including podcasts featuring select speakers. View the conference agenda.