Title: High Reliability Organization (HRO) in the inpatient setting
Abstract:
Learning Outcome: Understanding how to apply the five principles of HRO and applying them to an inpatient setting.
Target Audience: Ambulatory Leader, Inpatient Leader, Quality, and Risk.
Session Summary: Are “Near Misses” getting the attention, tenderness, Love, and Care they deserve? ReShape the work most leaders are already doing in the workplace embed the fundamental principles of HRO and capitalize on “Near Misses”. By restructuring huddles, utilizing the circle-up feedback system, and implementing a great catch award, the progressive care unit showered an increase in two composite metrics based on the AHRQ. Stop safety events before they happen!
Narrative: The term High-Reliability Organization (HRO) is attached to healthcare and many different industries. HRO is an industry or organization that avoids catastrophes or sentinel events in an environment where accidents are expected based on the complexity of the industry (Byrnes, 2018). All too often, the speak-up culture, which is the foundation of HRO comes to the surface after a tragic accident. For example, Boeing had two major airplane crashes. After an investigation, it was determined that the organization had embedded a culture that placed interpersonal safety over customers' safety (Gelles, 2021). Therefore, staff knew of potential mechanical and engineering issues, leaving those concerns unaddressed by leadership. This same phenomenon is why industries, including the healthcare sector, struggle to create a culture that embodies a psychological safety culture. A clinical example happened in Seattle, Washington, and the patient’s name was Mary McClinton. Mary was brought to the hospital to seek care for a brain aneurysm. A Computed Tomography Scan (CT) was ordered, and the technician prepped three solutions: Saline, Chlorhexidine, and Contrast. All three solutions are identical to the human eye and prepped in the same stainless steel bowls. The technician mistakenly used Chlorhexidine instead of the Contract for the CT scan. That error led to the death of Mary McClinton and prompted the hospital to rapidly change (Virginia Mason Institute, 2022). One research agency focusing on patient safety culture in the inpatient setting is” the Agency for Healthcare Research and Quality (AHRQ).” They define patient safety culture as determining rewarded, supported, expected, and accepted behaviors. The behaviors are embedded in the Surveys on Patient Safety Culture Hospital Survey 2.0 (SOPS Hospital Database, 2022). DaShaunn Woolard has defended his proposal and has IRB approval to conduct a DNP project on an inpatient progressive care unit. The population consists of the front-line staff and leadership. He will be operationalizing the principles of HRO and comparing the intervention to the staff’s baseline knowledge of HRO from annual education modules.
Impact: The framework of HRO can help bring awareness and provide a guide to improving patient safety culture in the inpatient setting. The two composite metrics focused on are “Response to Error” and “Hospital Management Support. These two metrics align with the strategic priorities of AONL focusing on the psychological safety of the nurse workforce and nurse leaders.
Outcomes: The timeline consists of the project starting in August 2024 and finishing by November 2024, with the results by December 2024 or January 2025. DaShaunn theorizes that the impact of the AHRQ Survey on the two composite metrics will be increased post-survey. In addition, a bell curve of improved reporting of near-miss safety events after staff further understand the power and value of reporting near-miss events and a taper after leadership has made systematic changes.
Implications to Practice: The three interventions can bring systematic improvements, suggestions, or ideas before reaching the patient. Improving psychological safety benefits patients, staff, the institution, and the community served.
Application to other settings: Huddles, Feedback, and Near-miss events are found across the continuum from the outpatient clinic to med/surg, progressive care, and the intensive care unit.
Lessons Learned: DaShaunn hopes to learn to partner with an outside unit, department, and organization as an outsider. The lessons learned will translate into actional learning takeaways for other leaders to take back to their institution.
Practical Takeaways: Improving psychological safety leads to decreased adverse outcomes for patients. Events like Mary McClinton or the 737 people who died aboard Boeing can be avoided.
