By Pat Rich, iPolitics
The concept of high reliability organizations (HROs) is gaining traction in the healthcare industry worldwide. The framework for this approach is based on the work from the 1970s which described how industries such as those in aviation and nuclear power minimized risk in settings where the cost of mistakes could be catastrophic.
Leaders from academic health science centres discussed HROs at the recent Academic Health Sciences Network National Symposium held Feb. 25.
An HRO is defined as one that has succeeded in avoiding catastrophes in an environment where normal accidents are expected due to risk factors and the complexity of the environment.
Chris Power, the CEO for the Canadian Patient Safety Institute moderated the panel discussion on HROs.
She noted that despite the emphasis on patient safety over the past decade “we still harm people at an alarming rate. Every 17 minutes in our hospitals in Canada someone dies from a preventable event.”
“As good as we are, we do fail all too often, and preventable harm is much more common than we think or want to believe,” echoed panelist Dr. Michael Apkon, President and CEO of the Hospital for Sick Children (SickKids) in Toronto.
Fellow panelist Dr. Peter Pisters, President and CEO, of the University Health Network in Toronto said the healthcare industry can be criticized for failing to learn lessons from other industries when it comes to preventing error.
Tracy Kitch, President and CEO at IWK Health Centre in Halifax and a panel member referenced a 2012 independent evaluation of the Canadian Patient Safety Institute, which included a survey of CPSI stakeholders where 94% of respondents indicated they had a formal patient safety role or mandate within their organizational structures. But Kitch said much more work must be done because errors and mistakes that cause harm continue to occur.
High Reliability Organizations have five principles as described by Apkon.
- A preoccupation with failure and vulnerability – with a retrospective and prospective focus
- A sensitivity to operations to ensure communications both horizontally and vertically
- A reluctance to simplify interpretations.
- A commitment to resilience
- A deference to expertise so decisions are made at the appropriate level
Apkon said SickKids is collaborating both internationally and locally to build on the expertise of other organizations to become a HRO. He said his institution is the first international participant in a 100-hospital collaborative coordinated from Cincinnati. At least three other Canadian centres are now involved with this, he said.
Apkon said SickKids has set the objective of reducing incidents of preventable harm by two thirds over three years. He noted it is possible to significantly reduce the number of serious events through this approach and he cited the experience of the Nationwide Children’s Hospital in Columbus, Ohio. He said this centre has reported a reduction of serious safety events by about 90% in three years. Other hospitals in the US have reported similar results by using this approach, he said.
However, in describing the initiatives to create a HRO at UHN, Pisters said the real goal for hospitals is to totally eliminate preventable errors. Kitch said to do this and incorporate all of the practices and principles of a safety culture requires a long term commitment. She said there is a need to compile results across many harm events and near misses and present data in a manner that identifies which safety systems need most improvement. There should be a consistency across institutions in reporting out and being transparent about performance, she said.
Kitch said it is clear major academic teaching institutions in Canada as a group have the collective knowledge and expertise to address patient safety and leaders can commit the healthcare industry to a set of collective deliverables.
Apkon noted that the HRO approach to patient safety creates some predictable tensions within the institution and those tensions are amplified for academic centres such as SickKids. He noted it is possible to significantly reduce the number of serious events through this approach and he cited the experience of the Nationwide Children’s Hospital in Columbus, Ohio. He said this centre has reported a reduction of serious safety events by about 90% in three years. Other hospitals in the US have reported similar results by using this approach, he said.
Pisters identified the support and engagement of the Board of the Directors and having the CEO lead the initiative as being core to the success of developing a HRO. He said there has also been a recognition that a collaborative effort between hospitals is the right approach to addressing patient safety and noted UHN itself has three aims in addressing patient safety and preventable events: to establish safety as a core value; to recognize the need for a new approach to safety – a coordinated effort around consistent goals; and to make the approach data-driven with a focus on six hospital-acquired conditions.
Kitch also discussed local community models to implement a safety culture noting that over 30 Nova Scotia CEOs (not all in health care) have signed a safety charter to commit to healthier and safer work environments with the sharing of best practices.
During question period, Apkon said the principles behind developing a HRO could be applied to institutions or clinics of any size. Having a network of academic health sciences centres working together also makes it easier for others to benefit from the work, he said, “This is not a hugely resource intensive effort,” he added.
Panelists raised very important issues regarding HROs and certainly made the case for putting more efforts in adopting a safety culture in our health organizations. The question is where do we go from now? As HealthCareCAN sees it, this concept ties in very nicely with the need to scale and spread innovative practices across the country. This should be a corner stone of the next Health Accord.