MEASUREMENT OF PATIENT SAFETY
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Data-driven decisions are an important part of an HRHO; therefore, careful monitoring of patient safety is essential. Scorecards can be used to track patient safety outcomes. For example, Pronovost and colleagues1 describe the framework for a patient safety scorecard in an HRO that includes the following: (a) How often do we harm patients (measured by the number of medical errors or sen- tinel events, such as catheter-associated blood stream infections)? (b) How often do we pro- vide interventions that patients should receive (eg, the proportion of patients who receive evidence-based interventions)? (c) How often do we learn from defects? (eg, the propor- tion of months that each patient care area learns from its mistakes and includes root- cause analysis along with revised policies to prevent future errors); (d) How well have we created a culture of safety? (eg, the percent- age of patient care areas in which 80% of the staff report a positive safety and teamwork cli- mate). The framework and concepts from an HRO are helpful in developing HRHOs. How- ever, it should be remembered that, although concepts from HROs can be used to improve processes and outcomes in health care sys- tems, they are not meant to replace safety and quality initiatives that are already be- ing implemented and successful in improving outcomes.
RECOMMENDATIONS FOR LEADERS TO CREATE HIGH-RELIABILITY CULTURES
A variety of strategies can be implemented by leaders to create HRHOs. The first strat- egy is to conduct transdisciplinary team train- ing in which all managers and staff are taught about HROs and methods to achieve them. The second strategy is deliberately designing key care processes to reduce risk and en- sure high-quality care. Third, it is important that all members of the team understand its key processes. Fourth, it is critical to error proof the organization. The fifth strategy in- volves process standardization (ie, uniformity in how care is delivered to patients).21 Finally, as part of building an HRHO, it is critical to cultivate a culture of EBP in which there is a never-ending spirit of inquiry within ev- eryone in the organization regarding how to improve the quality, safety, and efficiency of care.