Hospital culture can prevent unnecessary medical errors, yet most hospitals are slow to adopt a framework that prevents adverse events, Christine Schuster, RN, president and CEO of Concord, Mass.-based Emerson Health, wrote in an opinion piece published June 25 on MedPage Today.
"I have been a hospital CEO for the last 29 years, and before that I was a nurse on the front lines of care. In that time, I've learned an important truth: organizational culture can prevent unnecessary medical errors," Ms. Schuster wrote. "Many hospitals continue to rely on troubleshooting as they work. These hospitals and health systems, in adopting a reactive problem-solving methodology, run the risk of inviting unfortunate consequences. These range from lower-quality healthcare delivery and unfavorable patient outcomes to workforce shortages and financial instability."
The method she recommends is called high-reliability risk analysis. This framework is used by numerous industries that share characteristics with healthcare: intensely complex, demanding and heavily regulated settings where the margin for error is thin. Although hospitals are making progress toward increasing safety in clinical practice, more is needed, she wrote.
"Several years ago, we began a high-reliability journey. But like most other hospitals that decided to do the same, we practiced it piecemeal (other than a shared foundational framework). Some departments followed the methodology, while others acted independently. But because of the variables across the organization, it was difficult to sustain the successes gained in narrowing the risks to patients," Ms. Schuster wrote.
Once the COVID-19 pandemic hit, the standard for crisis control rose and the hospital revisited its safety reporting structure. In 2021, they trained the entire team in high-reliability methodology and revamped the policies hospitalwide. "It was systemic, wired into everything we do, across every department, and practiced continuously," she wrote.
Two programs were launched as part of the process: a daily safety huddle, where 50 more more leaders join a call to give safety status updates from every part of the hospital, and executive safety walk rounds, where senior leaders meet with frontline staff for the same process. The results: increased safety event reporting by 50 percent. The system also implemented an internal risk analysis process called collaborative case reviews.
"What changed at our hospital is this: We established high-reliability as an everyday practice, living and breathing it. In reinforcing the safety culture in our system, we rebuilt trust among frontline staff and, as a direct byproduct, decreased blame and finger-pointing," Ms. Schuster wrote. "Over time, our nurses felt freer to report safety issues. At first, they would report an issue only after the fact, once a problem reached a patient. But later, they also would report near-misses, such as a delay in treatment, where something that should not happen almost happened — and, equally as valuable, could happen again. Learning about potential problems matters at least as much as learning about existing problems. We then gain the opportunity to act preemptively rather than retroactively."
Staff were also coached to report issues each time it crops up rather than only once. The consistency and higher reporting volume allowed the hospital to detect risk in the system and measure the effect of corrective action.
"Admittedly, none of these changes were easy to make, nor will they be easy for other institutions," Ms. Schuster wrote. "But it is possible. We have found that high-reliability is essentially a management philosophy. To cultivate a culture that values safety above all, you must maintain an unwavering focus on communication, coordination, and collaboration among staff. It must go above and beyond freestanding safeguards such as hand-washing procedures or fall-prevention programs. In short, it must be systemic rather than incremental."