• Post category:Nursing
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HIGH-RELIABILITY ORGANIZATIONS(HROs) are those that achieve a high degree of safety or reliability despite dan- gerous or hazardous conditions.1 They have defect-free or error-free operations for long periods of time.2 The Blue Angels and the aviation industry are excellent examples of HROs. The Blue Angels are the United States Navy’s Flight Demonstration Squadron and the oldest formal flying aerobatic team. They operate 6 F/A-18 Hornet aircraft and conduct more than 70 daring flight exhibits every year throughout the United States in which they

Author Affiliation: College of Nursing, The Ohio State University, Columbus.

The author declares no conflict of interest.

Correspondence: Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210 (Melnyk.15@osu.edu).

DOI: 10.1097/NAQ.0b013e318249fb6a

Perform many extremely dangerous maneu- vers, including high-speed passes (often just under the speed of sound), slow passes, fast rolls, tight turns, and the Diamond formation. Training and performance require intense focus, strong leadership, effective commu- nication, teamwork, data-based practices, root-cause analysis of errors, a safety and continuous learning culture, improvement processes, and an outcomes evaluation.

The health care industry, which has been fraught with an epidemic of medical errors, has looked to HROs to learn about and imple- ment cultures along with practices that will lead to safer environments with a higher qual- ity of care and efficiency. Every year, there are up to 200,000 unintended patient deaths, more than the number of deaths that occur due to motor vehicle accidents, breast can- cer, and AIDS.3 Patient injuries happen to ap- proximately 15 million individuals per year. Only 5% of medical errors are caused by incompetence, whereas 95% of errors in- volve competent clinicians trying to attain the best outcomes in poorly designed sys- tems with poor uniformity.4 Furthermore, core processes in health care are defective 50% of the time and patients receive only ap- proximately 55% of the care that they should when entering the health care system.5

The movement to improve patient safety in health care systems accelerated after the land- mark publication by the Institute of Medicine of To Err Is Human: Building a Safer Health System.6 Evidence regarding major factors that reduce errors in health care systems in- clude (a) effective communication and trans- disciplinary teamwork; (b) evidence-based interventions, which also improve standard- ization of care and decrease variation; (c) sensitivity to operations; and (d) improved systems design, which includes the use of checklists, decreasing interruptions, prevent- ing fatigue, avoiding task saturation, reducing clinician stress, and improving environmen- tal conditions.1,7,8 In addition to the current emphasis on reducing medical errors, pay for performance has placed pressure on health care systems to improve their quality of care and prevent sentinel events.

One key strategy to improving quality of care is through the implementation of evidence-based practice (EBP). However, de- spite an aggressive research movement, the majority of findings from research are often not translated into clinical practice to enhance care and patient outcomes. At best, it usu- ally takes several years to translate research findings into health care settings to improve patent care. In an era of cost-driven health care systems, research that demonstrates a re- duction in costs has a higher probability of be- ing adopted in clinical practice. For example, through a series of 6 randomized controlled trials, the efficacy of the COPE (Creating Op- portunities for Parent Empowerment) pro- gram has been established with parents of hos- pitalized/critically ill children and premature infants. Findings from these trials have indi- cated that when parents receive COPE versus an attention control program, parents report less stress, anxiety, depression, and posttrau- matic stress symptoms, up to 2 years follow- ing hospitalization.9-14 In addition, their chil- dren have better developmental and behavior outcomes. However, it was not until a clini- cal trial using COPE with parents of preterms demonstrated a 4-day shorter length of neona- tal intensive care unit (ICU) stay (8 days shorter for preterms younger than 32 weeks) that hospitals and insurers began implement- ing the program.10 Routine implementation of the COPE program to the parents of the more than 500 000 preterm infants born in the United States every year could save the health care system between $2.5 billion and $5 bil- lion per year.15 This is an example of the “so what factor” in an era of health care reform, which is conducting research and EBP/quality improvement projects with high-impact po- tential to positively change health care sys- tems, reduce costs, and improve outcomes for patients and their families.16 Key questions that anyone should ask themselves when em- barking on a research study or EBP/quality improvement project should be as follows: (1) So what will the outcome of the study or project be once it is completed? and (2) So what difference will the study or project make in improving health care quality, costs, or patient outcomes?

Estimates are that the cost of health care de- livery in the United States is $2.3 trillion a year, a tripling of its cost in the past 2 decades.17

Poor quality health care cost the United States approximately $720 billion in 2008. Wasteful health care spending costs the health care sys- tem $1.2 trillion annually. Half of American hospitals are functioning in deficit.18 In addi- tion to EBP improving patient outcomes by at least 28%, the US health care system could re- duce health care spending by 30% if patients receive evidence-based care.19