Truly Highly Reliable: Practical Tools to Help Your Organization Take Ownership of Its HRO Journey

October 25, 2017 | Strategic Insights for Health System


​Because "things are always changing in healthcare, you need to know what's going on," said Christopher Hund, director of quality for the American Hospital Association, on October 17, 2017, at the American Society for Healthcare Risk Management (ASHRM) conference in Seattle, Washington. Hund defined high-reliability organizations (HROs) as those that "have processes and systems in place that are exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors." Hund focused on five characteristics of HROs. The first, "sensitivity to operations," invokes the concept of situational awareness, as does the Agency for Healthcare Research and Quality's TeamSTEPPS program. Situational awareness, or "knowing what is going on around you," requires a shared mental model. A shared mental model results when team members "are on the same page." Hund recommends using the TeamSTEPPS communication tool SBAR (situation, background, assessment, recommendation) to foster the shared mental model. The second HRO principle is "preoccupation with failure." Hund contends that in an HRO "failures are expected." Failures are reviewed and create opportunities for change. TeamSTEPPS tools that foster the proper focus on failure include briefs, debriefs, and huddles. Hund exclaimed, "Anyone can huddle!"

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