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High Reliability: A Strategy to Support a Safe Environment and Commitment to Safety

Posted By Administration, Wednesday, July 23, 2014
Updated: Tuesday, September 2, 2014
Comments on the session “The High Reliability Chassis: Improving Patient and Employee Safety” at the 2014 NPSF Patient Safety Congress in May (Orlando).

By Lorri Zipperer, MA


I have been intrigued by high reliability and organizations that foster it as a direction for patient safety improvement since reading Weick and Sutcliff’s classic business text Managing the Unexpected (2001). Building on that interest, I have since led and participated in efforts to apply high-reliability concepts to my consulting interests, professional development, and local community building (Zipperer 2006, 2014; Attaining High Reliability 2014).


So naturally I wanted to take in the session at the 2014 NPSF Congress related to high reliability and workforce safety (Johnson and Deck 2014). Speakers Kerry Johnson of HealthCare Performance Improvement and Marcia Deck, MD, of WellStar Health System, introduced the essential characteristics of high reliability as defined by Weick and Sutcliff into their session in a fresh way. With a mix of theory, success stories from non–health care, high-consequence industries we are all accustomed to hearing about in our safety work (aviation and nuclear industry safety), and implementation advice, they focused their comments on the importance of: 
  • Seeing safety as a science to enable the application of high-reliability principles to achieve the safety we seek
  • Recognizing the criticality of senior leader champions as a high-reliability attainment strategy
  • Understanding that safety is a dynamic “non-event” that all in health care have a role in creating
  • Establishing safety as a core value for medical staff
  • Acknowledging that humans err, and that serious incidents resulting in patient harm are almost always the result of system failure
  • Enabling all health care workers to consistently apply error prevention strategies in their daily work
Obviously each bullet here could have been the topic of its own session. Johnson and Deck wove these ideas into their discussion through an emphasis on how a foundational culture needs to be in place to allow these elements to take hold and be meaningful to those in health care: from patients to executive leadership.
The example of WellStar, a 5-hospital, 1321 bed, safety net, health care system in the southeastern United States, anchored the discussion. Their experience provided a real-world glimpse of how the often-considered “academic” approach to establishing a hospital as a high-reliability organization (HRO) can work. Their illustration underscored the importance of aligning HRO elements with a systems-level quality agenda and tactics. It also reinforced the value of implementing programs that support commitment to both patient and worker safety improvement as being part of the cultural fabric of the organization. WellStar initiatives such as a peer coach program, an error prevention toolkit, and daily leadership huddles were established to help engage staff as team members to provide diagnostic assessments of safety gaps in the system. The safety culture enabled an environment to brainstorm, envision, and implement a range of interventions that resulted in reductions in workman’s compensation claims by almost 50% and improved employee satisfaction (see figure).


 WellStar Health System’s workers’ compensation costs, 2007–2011
WellStar Health System’s workers’ compensation costs, 2007–2011
As the Lucian Leape Institute’s report Through the Eyes of the Workforce highlighted for us all, creating a culture that brings joy and meaning to work in health care is an effective strategy for safety improvement. The experience reported by Johnson and Deck provided an active example that attention to employee safety is valuable and effective. Partnering to embrace the elements of reliability can help health care staff to feel safer which, in turn, empowers clinicians and the staff that support them, to provide safe care to the patients, families, and communities they serve.
Are you also intrigued with how high-reliability principles might be applied in your organization? Does your organization recognize worker safety as part of that effort or as a part of the overall patient safety program? 
Lorri Zipperer, MA, is the principal at Zipperer Project Management in Albuquerque, NM, specializing in knowledge management efforts and bringing multidisciplinary teams together to envision, design, and implement knowledge sharing initiatives. Among her publications, Ms. Zipperer recently served as editor for two texts, Knowledge Management in Healthcare and Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer, both published earlier this year by Gower Publishing (UK).


Attaining High Reliability and Safety for Patients – Collaborating for Change. March 6–7, 2014. Conference presented by the Patient Safety Collective of the Southwest, Albuquerque, NM. [see in context]


Johnson K, Deck M. May 16, 2014. The High-Reliability Chassis: Improving Patient and Employee Safety. Presentation at NPSF Patient Safety Congress, Orlando, FL. [see in context]


Lucian Leape Institute. 2013. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. Boston, MA: National Patient Safety Foundation. [see in context]


Weick KE, Sutcliffe KM. 2001. Managing the Unexpected: Assuring High Performance in an Age of Complexity, 1st edition. San Francisco, CA: John Wiley & Sons. [see in context]


Zipperer, L. ed. 2014. Knowledge Management in Health Care. London, UK: Gower. [see in context]


Zipperer L. October 2006. High reliability, information work and patient safety. National Network 31:4–5, 7. [see in context]


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