The nuclear and healthcare industries share much in common. Both operate in high-risk environments and place great priority on workplace safety. However, the concept of zero harm — often considered an unwavering standard in other high-risk industries, like nuclear energy — remains difficult to achieve in the healthcare arena.
As health systems seek to improve workplace safety, they should look to strategies high reliability organizations use to foster safe working conditions in high-risk industries. The Agency for Healthcare Research and Quality defines high reliability organizations as those "that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures."
By borrowing certain governance structures from these high reliability organizations, health systems can embed a more robust safety culture into their own facilities, according to Gary Yates, MD, a partner in Press Ganey's strategic consulting group and an expert in safety and high reliability science.
"Leaders, clinicians and support staff want to deliver excellent care to every patient," he says. "High reliability organizations outside of healthcare have shown us that getting culture right is an important piece of that puzzle."
Dr. Yates has nearly two decades of clinical and leadership experience pertaining to quality improvement. He most recently served as vice president and CMO of Norfolk, Va.-based Sentara Healthcare and president of Sentara Quality Care Network. Dr. Yates also acted as president of the consulting firm Healthcare Performance Improvement, which Press Ganey acquired in 2015.
Becker's Hospital Review spoke with Dr. Yates about high reliability in healthcare and how health systems can use this concept to improve their own patient safety culture.
Editor's note: Responses have been lightly edited for length and clarity.
Question: How has your clinical experience shaped your views on patient safety?
Dr. Gary Yates: I learned a number of key lessons during my time helping lead quality and patient safety efforts as a health system leader. Back in the 2002-03 time frame, several of us were concerned we weren't making sufficient progress in patient safety. It seemed slow and siloed. So we began to look outside of healthcare for models to improve patient safety. We started to thoughtfully introduce concepts from high reliability organizations into the healthcare environment and saw some progress we hadn't seen before.
We learned that to be successful, it's important to take a strategic approach to improving safety and reliability. Tactics to improve safety implemented in the absence of a comprehensive strategy are likely to have only limited success and are unlikely to be sustained over time. Second, creating a robust culture of safety is essential to making significant progress in reducing harm. And third, alignment between the board, senior operational leaders and clinical leaders is critical to successfully drive the kind of culture transformation needed in a journey to high reliability.
Q: Why is the concept of zero harm a targeted goal in healthcare, but a strict principle in other industries?
GY: Focusing on zero harm really is fundamental. This focus leads us to take the necessary actions and adopt the strategies that will effectively move us forward. Other industries have longer experience trying to create ultrasafe performance, and hopefully in healthcare, we can learn from them so we can improve safety faster and more efficiently than they did.
Q: What principles can healthcare leaders take from these other industries to improve patient safety?
GY: Although authors have described what makes other high reliability organizations highly reliable, no one has written the "how-to manual." So that's why it's important to thoughtfully look at how we can adapt some of those strategies. Karl Weick and Kathleen Sutcliffe, some of the most widely read authors on the topic, identified several characteristics of high reliability organizations. One characteristic is "mindfulness," which consists of being preoccupied with failure or constantly looking for minor deviations that could turn into major problems if left unchecked. Another characteristic is sensitivity to an organization's operations. As leaders, we need to be very focused on what's going on at the frontline to get ahead of small problems before they turn into a significant harm for patients.
Q: What is a common mistake hospitals make when trying to implement new patient safety initiatives?
GY: One challenge is when hospitals or health systems implement new tactics without having them formally embedded in an overall strategy. It's important to get alignment in an organization by explaining the "why" behind the implementation of a new technique, tool or tactic. In some cases, hospitals and health systems haven't spent as much time on the why to make sure it is well understood. Aligning medical staff, administrative staff and others around what the change is and being sure it's embedded in a clear strategy everyone understands is important. Unfortunately, tactics implemented without that sort of alignment won't be as effective or sustained for as long as hoped.
Q: What role does technology play in patient safety? How can hospitals harness new technologies to improve care and reduce adverse events?
GY: Improved technology is an important piece of the puzzle to improving patient safety. But it won't fix all of the problems by itself. So, we need to continue to work on improving our overall care systems. At the same time, we need to better understand the interface between people and the technology. We could actually create new safety problems if we introduce new technology, but don't spend the time to properly train the individuals who will be using this technology. We also need to focus on more thorough testing of new technology as it comes through the pipeline. There are a number of centers focused on studying how people interact with new technology and how this technology can be implemented as intended to achieve the best outcomes.
Q: What are you working on right now that excites you?
GY: One exciting area we're working in now is using high reliability organizing to create a "chassis" that can be used to improve not only patient safety, but other critical dimensions of performance, including workforce safety, quality and the patient/family experience of care. Historically, many hospitals and health systems have taken a siloed approach to improving performance in these areas. Patients are interested in care that is safe, high quality and patient-centered, so we need to deliver reliably across all three domains to meet our promise to patients and families. We are working to refine a roadmap for hospitals and health systems who are interested in using high reliability organizing to improve all three.