Resources: High Reliability In Health Care Organizations
Relevant Standards
- CMS: §482.21 Condition of Participation: Quality Assessment and Performance Improvement
Program (A-0265, A-0275, A-0276-7, A-0286, A-0291, A-0310, A-0311, A-0312)
- TJC: LD.03.01.01, LD.03.05.01
References & Tools
- TJC High Reliability Resource Center
- High-Reliability Health Care: Getting There from Here[®]
- Leadership (1-Board, 2-CEO/Management, 3-Physicians, 4-Quality Strategy, 5-Quality Measures, 6-Information Technology)
- Culture of Safety (7-Trust, 8-Accountability, 9-Identifying unsafe conditions, 10-Strengthening systems, 11-Assessment)
- Robust Process Improvement (12-Methods, 13-Training, 14-Spread)
- Leadership (1-Board, 2-CEO/Management, 3-Physicians, 4-Quality Strategy, 5-Quality Measures, 6-Information Technology)
- The Ongoing Quality Improvement Journey: Next Stop, High Reliability (PDF)[®] – Seminal article by Dr. Chassin
- High-Reliability Health Care: Getting There from Here[®]
- Handouts from 2012-2013 Leadership Interviews
- Key Factors for HROs
- Leadership
- Safety Culture
- Robust Process Improvement (@ TJC Center for Transforming Healthcare)
- TJC’s RPI Corner
- What is Robust Process Improvement (3/6/14)
- Lean Six Sigma
- Change Management Methodologies
- Six Sigma Basics – DMAIC – Description of process with suggested tools for each step
- Six Sigma Basics – DMAIC – Description of process with suggested tools for each step
- Other Tools [e.g., Flow Charts, Pareto Charts, Value Stream Mapping (VSM)]
- TJC’s RPI Corner
- Webinar: Applying High Reliability Principles to the Prevention and Control of Infections in Long Term Care[®] – 50-minute e-learning tool that includes examples, quizzes, discussion questions… to learn and test… knowledge about high reliability in health care.
- Internet Articles
- Accelerating the Adoption of a Safety Culture from Healthcare Executive (March/April 2015) – Contains interview with Dr. Ana McKee, Chief Medical Officer, TJC and brought to our attention by Mark Pellitier, RN, MSN, Chief Operating Officer, TJC
J*_LD03_High Reliability Organizations
- VIEWPOINT: Improving The Quality Of Health Care: What’s Taking So Long?[®] by Mark R. Chassin, MD Health Affairs October 2013 Volume 32, Issue 10 pg:1761-1765;
- Becoming a High Reliability Organization- Operational Advice for Hospital Leaders[®] – Agency for Healthcare Research and Quality, April 2008
- Promoting health care safety through training high reliability teams[®] from BMJ Quaity & Safe Health Care 2005;14:303–309
- Accelerating the Adoption of a Safety Culture from Healthcare Executive (March/April 2015) – Contains interview with Dr. Ana McKee, Chief Medical Officer, TJC and brought to our attention by Mark Pellitier, RN, MSN, Chief Operating Officer, TJC
- The Power of Zero: Steps Toward High Reliability Healthcare[®] by Ellen Lanser May, Healthcare Executive, Mar/Apr 2013
Required Written Documents
- None
** Additional Clarifications & Compliance Strategies (Premier)**
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• Stages of Maturity in Health Care Organizations’ Path to High Reliability,[®] The Source, August 2011, Volume 9, Issue 8 [PEARL: LDR, GB]
Reading Tips Review – Aug 2011, Vol 5, #8:
In April and May of this year, TJC began using an article by Drs. Chassisn and Loeb entitled, “The Ongoing Quality Improvement Journey: Next Stop, High Reliability (PDF)1108” to encourage the healthcare field towards the concept of ‘High-Reliability’. In our review of the article, The Joint Commission Urges Health Care Organizations to Focus on Achieving High Reliability (Perspectives, May Vol31, #5 pg 3), we noted TJC’s recommendation that organizations assess themselves on readiness for being/becoming a high-reliability organization. This article
provides a self assessment grid for rating your facility’s stage of maturity in the three factors considered critical for high-reliability: 1 – leadership making high reliability a priority; 2 – creating a culture of safety and 3 – utilizing proven quality improvement methods such as Lean Six Sigma and change management (aka Robust Process Improvement). Even if ‘High-Reliability’ is not on your radar, leaders would benefit from taking a couple of minutes to peruse the chart for the insight and impetus it might provide… on the future of healthcare???
The Joint Commission Urges Health Care Organizations to Focus on Achieving High Reliability Perspectives, May 2011, Vol 31, #5, Pg03 – FYI: JCSC, LDR,
Reading Tips Review – May 2011, Vol 5, #5:
The urging is done in an article by Drs Chassin and Loeb, entitled, The Ongoing Quality Improvement Journey: Next Stop, High Reliability and it is available for free download. The authors call for something they admit has never been achieved; consistent performance by healthcare organizations at high levels of safety over long periods of time or “high reliability”. The key to achieving this ambitious goal is in leadership making high reliability a priority; creating a culture of safety and utilizing proven quality improvement methods such as Lean Six Sigma and change management (aka Robust Process Improvement). The authors also urge TJC hospitals to self assess these areas. As we indicated last month in our first review of this article, we believe this is an important evolving concept and direction for TJC. See also Drs. Chassin/Loeb article focuses on high reliability and health care (JC Online 4/6/11)[®]
JCO 4/6/11
Health Affairs article written by Drs. Chassin and Loeb publishes tomorrow, focuses on high reliability and health care [ALERT: PI, LDR, GB]
The concept of safety and performance improvement within TJC continues to evolve as indicated by the
comments of TJC leadership in this recent article. Here the focus is on consistent performance by
healthcare organizations at high levels of safety over long periods of time… or “high reliability”. The
article lists the three requirements for achieving high reliability as Leadership Commitment, having a
Safety Culture and utilizing Robust Process Improvement. All three have been points of emphasis by
TJC in recent years. The full article, The Ongoing Quality Improvement Journey: Next Stop, High
Reliability , is available for free download. This is another indicator of TJC philosophical direction that
LDR, GB and PI would be wise to be more aware of.
• Making Health Care a High-Reliability Industry: The Joint Commission Launches Center for Transforming Healthcare [®] Patient Safety, November 2009, Volume 9, Issue 11, Pg 10 FYI: JCSC, PI, IC, RN.
Reading Tips Review – Nov 2009, Vol 3, #11:
TJC’s new Center for Transforming Healthcare began in September of 2009. TJC says “The center brings together the leading hospitals and health systems in the United States to identify specific underlying causes to patient safety problems and develop targeted solutions to solve those problems, and then share those solutions with health care organizations nationwide.” Essentially, its mission is to reduce the occurrence of key
preventable errors in healthcare. [PEARL] To that end they will be employing a process utilizing tools and methods from Lean Six Sigma called Robust Process Improvement. LDR and PI should increase awareness of these approaches as TJC announced last year its intent to adopt this new change strategy. These approaches are thought to be more effective than PI/QI in producing and maintaining excellence, particularly in challenging, improvement-resistant work processes. The Center’s first project addressing hand hygiene and HAIs has already begun to identify important causal factors and recommended solutions. One of its next projects will target patient handoffs with a report expected in December 2010. A word to the wise. The article says you may expect to hear and see more about the findings/recommendations from the centers projects on TJC’s intranet and even as a part of surveyor process. For more on RPI and TJC see: Sustaining the Improvement We Need by Mark R. Chassin, MD (11/6/08) [especially slides 16-21] [HTML] (PDF) For more info on Lean, Six Sigma and Lean Six Sigma goto our SL1 library page on PI & Data Management Tools