In high-risk industries where people and organisations operate within complex systems, and serious errors can have catastrophic outcomes, it is commonly accepted that there is a need to have high-reliability organisations (HRO’s). A HRO can be defined as one that operates ‘in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures’[1].
Yet in healthcare, where serious errors can have potentially life-changing consequences and may in the worst cases result in the death of a patient, there is no consistent application of the principles of high reliability. Avoidable harm is a stubbornly persistent problem, resulting in an estimated 11,000 deaths in England annually, with the World Health Organization (WHO) estimating that unsafe care is one of the 10 leading causes of death and disability globally.
In this joint series of blogs and video conversations, RLDatix, the leading global provider of intelligent patient safety solutions, and Patient Safety Learning, a charity and independent voice for patient safety, will explore how we can improve patient safety through the application of the principles of high-reliability in healthcare.
What do we mean by high reliability organisations?
According to Weick and Sutcliffe, HRO’s can be defined by five key characteristics [2]:
- Preoccupation with failure – everyone in the organisation is aware of and thinking about the potential for failure.
- Reluctance to simplify – organisations resist the urge to simplify the understanding of their work processes when considering how and why activities succeed or fail in their environment.
- Sensitivity to operations – striving to maintain a high awareness of operational conditions, underpinned by an acceptance and understanding of their complexity.
- Commitment to resilience – everyone working on the assumption the system is at risk of failure, therefore undertaking activities aimed at responding to this and ensuring that the organisation can continue to function in these circumstances.
- Deference to expertise – an acknowledgement that in a crisis or emergency the person with the greatest knowledge may not be the person with the highest status. Expectation that everyone shares safety concerns, and all staff are able to speak up about potential safety issues.
High reliability, healthcare and patient safety
Creating highly-reliable health systems and organisations will plays a key role in seeking improvements to patient safety and enabling healthcare to learn from the experience of other high-risk industries such as aviation and nuclear power. This is recognised by the WHO, who have identified this as one of their seven strategic objectives in the Global Patient Safety Action Plan 2021-2030 [3].
In its report A Blueprint for Action, Patient Safety Learning sets out what is needed to progress towards a patient-safe future [4]. Underpinned by systemic analysis and evidence, it sets out six foundations of safe care for patients and proposes practical actions to address them. Principles of high-reliability, with safety placed at the core of healthcare and the importance of examining the underlying systemic causes of safety issues, are key components in helping to achieve these six foundations of safe care.
This series
Throughout this series RLDatix and Patient Safety Learning will set out practical applications of high reliability principles in healthcare, considering how they fit within the context of risk management. We will also consider the vital role that investing in processes plays in enabling this change and the importance of organisations making decisions on what they want to achieve in this respect and these being both measurable and achievable.
Next in the series will be the first of our ‘In conversation with…’ sessions, where Phil Taylor, Chief Product Officer at RLDatix and Helen Hughes, Chief Executive of Patient Safety Learning, provide an overview of the series. They will discuss why it is important that healthcare organisations seek to become high reliability organisations and the important role that organisational culture plays in how organisations report, analyse and act on patient safety problems.
[1] Agency for Healthcare Research and Quality, Patient Safety Primer: High Reliability, Last Update September 2019. https://psnet.ahrq.gov/primer/high-reliability
[2] Karl Weick and Kathleen Sutcliffe, Managing the Unexpected: Sustained Performance in a Complex World, 2015.
[3] World Health Ogranization, Global Patient Safety Action Plan 2021-2030: Towards Eliminating Avoidable Harm in Healthcare, Third Draft January 2021. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/gpsap/global-patient-safety-action-plan-2021-2030_third-draft_january-2021_web.pdf?sfvrsn=6767dc05_13
[4] Patient Safety Learning, The Patient-Safe Future: A Blueprint for Action, 2019. https://s3-eu-west-1.amazonaws.com/ddme-psl/content/A-Blueprint-for-Action-240619.pdf?mtime=20190701143411&focal=none
