The HRH model was developed by the Veterans Health Administration's National Center for Patient Safety (NCPS) and its process is open for all facilities to adopt.
Editor's note: This article was originally published by the HCPro Accreditation & Quality Compliance Center.
In 2016, Truman VA Medical Center in Columbia, Missouri took part in a three-year project to become a high-reliability hospital (HRH).
By the end of the study, Truman reported that its patient outcomes had improved, low-harm errors were being reported more often, and that quality improvement education had become self-sustaining within the facility.
The HRH model was developed by the Veterans Health Administration’s National Center for Patient Safety (NCPS) and its process is open for all facilities to adopt.
The full study, “A High-Reliability Organization Framework for Health Care: A Multiyear Implementation Strategy and Associated Outcomes,” was published in the Journal of Patient Safety.
In March, Patient Safety Monitor Journal interviewed one of the lead study authors, Gary L. Sculli, MSN, ATP, one of the study authors and the director of clinical training programs at NCPS, about how the HRH project came to be and what made it work.
Here are the 10 steps that Truman and researchers used to become an HRH.
- A baseline and yearly assessment/patient safety site visit
During these visits, the NCPS used a standardized assessment tool comprising a series of questions, evaluated facility root cause analysis (RCA) reports, and assessed Truman’s compliance with NCPS Patient Safety Alerts and Advisories.
- Patient safety culture assessment
The assessments were made using two different methodologies, a Patient Safety Culture Survey (PSCS) and a Teamwork and Safety Climate Questionnaire (TSCQ), which were done six and 12 months after staff received Clinical Team Training (CTT).
- Annual frontline staff RCA training
NCPS provided annual RCA training to a group of Truman frontline staff, who then trained latter groups of staff. This training covered risk scoring, team composition, event flow diagramming, interviewing techniques, root cause statements and rules of causation, strength of action planning, and outcome measures.
- Leadership walk-arounds
Truman implemented a Leader Walk-Around Program, where the leadership team conducted monthly in-person conversations with frontline staff to gather direct input, respond to concerns, and reinforce HRH principles.
- Monthly patient safety forum
These patient safety forums were open to all Truman staff and leadership. During these, attendees would review adverse events that triggered an RCA, discuss system root causes and corrective actions, and celebration of staff members who identified and acted upon on safety concerns.
- Annual assessment of infrastructure and processes for standardization
A standardization team was assembled annually to review infrastructure and processes that had high levels of variability to establish a strategic plan. The team then selected an annual project to work on.
- Just Culture training
The NCPS conducted interactive Just Culture training for facility leadership, midlevel managers, and frontline supervisors to convey Just Culture core concepts including the application of a Just Culture decision support tool to case studies.
- Clinical Team Training for all units
Clinical Team Training (CTT) comprised an initial training session, an annual unit-based safety project, monthly NCPS coaching sessions, and one-year refresher training on topics such as high reliability organization theory, threat and error management, participatory leader behaviors, and effective follower behaviors.
- Unit-based improvement project implementation and monitoring
Each month, staff were required to identify a patient safety challenge and implement an improvement project.
- CTT simulation education
The NCPS educated the Truman staff in the use of simulation to provide opportunities for unit-based teams to practice the communication, teamwork, and situational awareness tools imparted in the program. The NCPS held an annual simulation “boot camp” instructing facility-based simulation educators on delivering unit-based curriculum.
Brian Ward is an associate editor for HCPro who writes about hospital accreditation and patient safety.
Photo credit: Kansas City, Missouri / USA - May 23 2019: Sign at Entrance of Truman Medical Center Lakewood / Editorial credit: Jon Kraft / Shutterstock.com