"We can't be satisfied with 5% better anymore," Chassin said.
Aircraft carrier flight deck and amusement park safety operations have "a bunch of things in common," Chassin continued. "They have very effective process improvement tools that allow them to create nearly perfect safety processes."
And, he said, "their culture encourages, obligates, and expects every person who works in the organization, from the most senior to the most junior, to be looking carefully at every process they touch every day [asking] 'Is this exactly the same as when it was performing perfectly yesterday?'
And they do this "before they create situations in which amusement park visitors might be harmed, when they're easy to fix. They're identified, recognized early, [and] they are reported, to the organization, [which] uses those effective process improvement tools to fix the process and that improvement is reported back to the folks who reported it in the first place. And that's how those organizations stay safe."
In healthcare, "we're too often facing a patient who's already been harmed, and then we try to work back with adverse event investigations, root cause analyses, asking why did it happen. And then try to figure out how we can fix our defenses so it doesn't happen again. But that's not how these organizations stay safe."
There are major efforts that must be strengthened and reinforced, he said. And the science of high reliability must play a more important role.
First, healthcare workers must trust each other from management down to housekeeping.
Trust means healthcare workers need to know they will be protected from "slings and arrows from their peers" when they step up and say there's a problem over here that needs to be fixed right away. And they need to trust that management "won't ignore or blame" the worker for reporting it.