Hospitals Still Far from Being Highly Reliable
The Milbank Quarterly article urges specific actions to improve patient safety
September 17, 2013
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(OAKBROOK TERRACE, Ill. – September 17, 2013) An article published Sept. 13, 2013, in The Milbank Quarterly urges hospitals to make the substantial changes that will be needed to achieve the ultimate goal of zero patient harm by adapting lessons from high-risk industries. The article “High-Reliability Health Care: Getting There from Here,” was written by Joint Commission President and CEO Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., along with Jerod M. Loeb, Ph.D., executive vice president for healthcare quality evaluation, The Joint Commission.
Chassin and Loeb report that too many hospitals and health care leaders currently experience serious safety failures as routine and inevitable parts of daily work. To prevent the harm that results from these failures, which affects millions of Americans each year, the article specifies a framework for major changes involving leadership, safety culture and robust process improvement. This framework is designed to help hospitals make progress toward high reliability, which is the achievement of extremely high levels of safety that are maintained over long periods of time---safety comparable to that demonstrated by the commercial air travel, nuclear power, and amusement park industries.
The Joint Commission tested the high-reliability framework, detailed in The Milbank Quarterly, at seven U.S. hospitals, as well as through face-to-face meetings and testing with health care leaders. In the article, Chassin and Loeb outline the 14 components of the high-reliability framework and contend that:
- Hospital leadership must commit to the ultimate goal of high reliability or zero patient harm rather than viewing it as unrealistic. The leadership section of the framework identifies specific roles for the board of trustees, the chief executive officer and all senior management (including nursing leaders), the engagement of physicians, the hospital quality strategy, its use of data on measures of quality and the use of information technology to support quality and safety improvement.
- Hospitals must create a culture of safety that emphasizes trust, reporting and improvement. This means hospitals must put a stop to the intimidation and blame that drive safety concerns underground and instead emphasize accountability and the early identification of unsafe practices and conditions. A systematic approach that includes safety culture measurement is crucial.
- Hospitals need new process improvement tools and methods—a combination of Six Sigma, Lean, and change management (known together as Robust Process Improvement™ )—in order to make far greater progress toward eliminating patient harm. Government regulation is unlikely to drive high reliability, but identifying and eliminating mandates that either do not directly contribute to or distract from quality challenges is necessary. Well-crafted programs that require public reporting of reliable and valid quality measures are also recommended.
“Although no hospital has been able to achieve high reliability, there are some very practical changes that can be made to improve safety and quality” says Dr. Chassin. “The time is now to start taking the steps needed to get from where we are today to where we want to be.”
The article by Chassin and Loeb notes that the primary drive for change must come from within the health care industry and from hospitals themselves. The Joint Commission is developing an assessment tool that will allow hospitals to measure their current state of maturity across each of the high-reliability framework’s 14 components. In addition, The Joint Commission is field testing tools that can be used to work toward high reliability.
The Joint Commission is committed to taking a leadership role in this effort and is using its reach across more than 20,000 diverse accredited health care organizations. In addition to the High Reliability Self Assessment Tool, Joint Commission accreditation standards (Leadership, National Patient Safety Goals, Performance Improvement) emphasize the need to create a culture of safety and to continuously improve performance. The Joint Commission Center for Transforming Healthcare is also helping health care organizations use Robust Process Improvement™ tools to create customized solutions to quality and safety issues such as hand hygiene, reducing errors in hand-offs between caregivers, wrong site surgery, surgical site infections, preventing falls that injure patients, and others.