Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study.

BACKGROUND The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. METHODS Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. RESULTS Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. DISCUSSION The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.

[1]  Katherine B Percarpio,et al.  A cross-sectional study on the relationship between utilization of root cause analysis and patient safety at 139 Department of Veterans Affairs medical centers. , 2013, Joint Commission journal on quality and patient safety.

[2]  Garill Coles,et al.  Using failure mode effects and criticality analysis for high-risk processes at three community hospitals. , 2005, Joint Commission journal on quality and patient safety.

[3]  Anthony P. Ciavarelli,et al.  Differences in Safety Climate between Hospital Personnel and Naval Aviators , 2003, Hum. Factors.

[4]  J. Rudolph,et al.  Design of high reliability organizations in health care , 2006, Quality and Safety in Health Care.

[5]  Julia Neily,et al.  Root cause analysis of serious adverse events among older patients in the Veterans Health Administration. , 2014, Joint Commission journal on quality and patient safety.

[6]  M. Chassin,et al.  The ongoing quality improvement journey: next stop, high reliability. , 2011, Health affairs.

[7]  Paul Barach,et al.  Creating Effective Leadership for Improving Patient Safety , 2002, Quality management in health care.

[8]  David W. Baker,et al.  Building the Road to High Reliability. , 2016, Joint Commission journal on quality and patient safety.

[9]  L L Leape,et al.  Safe health care: are we up to it? , 2000, BMJ : British Medical Journal.

[10]  M. Shabot,et al.  Memorial Hermann: high reliability from board to bedside. , 2013, Joint Commission journal on quality and patient safety.

[11]  P. Barach,et al.  High reliability organizations and surgical microsystems: re-engineering surgical care. , 2012, The Surgical clinics of North America.

[12]  Robert M Wachter,et al.  Patient safety at ten: unmistakable progress, troubling gaps. , 2010, Health affairs.

[13]  Karl E. Weick,et al.  Managing the unexpected: Assuring high performance in an age of complexity. , 2001 .

[14]  Ana Herranz-Alonso,et al.  Use of failure mode, effect and criticality analysis to improve safety in the medication administration process. , 2015, Journal of evaluation in clinical practice.

[15]  Marlene R. Miller,et al.  Creating a High-Reliability Health Care System: Improving Performance on Core Processes of Care at Johns Hopkins Medicine , 2015, Academic medicine : journal of the Association of American Medical Colleges.

[16]  J. Cullen,et al.  Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect analysis. , 2011, AORN journal.

[17]  Alan Hobbs,et al.  Managing Maintenance Error: A Practical Guide , 2003 .

[18]  W. Berta,et al.  The relationship between organizational leadership for safety and learning from patient safety events. , 2010, Health services research.

[19]  G. Young,et al.  Best practices for managing surgical services: the role of coordination. , 1997, Health care management review.

[20]  Ingrid M. Nembhard,et al.  Assessing the Evidence of Six Sigma and Lean in the Health Care Industry , 2010, Quality management in health care.

[21]  Denise M. Rousseau,et al.  The culture of high reliability: quantitative and qualitative assessment aboard nuclear-powered aircraft carriers , 1994 .

[22]  Gary J. Young,et al.  Validating risk-adjusted surgical outcomes: site visit assessment of process and structure1 , 1997 .

[23]  Harlan M Krumholz,et al.  What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? , 2011, Annals of Internal Medicine.

[24]  M. Chassin,et al.  High-Reliability Health Care: Getting There from Here , 2013, The Milbank quarterly.

[25]  M. Chassin,et al.  Improving patient satisfaction with pain management using Six Sigma tools. , 2009, Joint Commission journal on quality and patient safety.

[26]  Jennifer L. Sullivan,et al.  Examining the Validity of AHRQ’s Patient Safety Indicators (PSIs) , 2014, Medical care research and review : MCRR.

[27]  J. Griffith Understanding High‐Reliability Organizations: Are Baldrige Recipients Models? , 2015, Journal of healthcare management / American College of Healthcare Executives.

[28]  H. Abujudeh,et al.  Root-cause analysis and health failure mode and effect analysis: two leading techniques in health care quality assessment. , 2014, Journal of the American College of Radiology : JACR.

[29]  M P Charns,et al.  Patterns of coordination and clinical outcomes: a study of surgical services. , 1997, Health services research.

[30]  Stephen E. Muething,et al.  Reliability science and patient safety. , 2006, Pediatric clinics of North America.

[31]  Carmen Guadalupe Rodriguez-Gonzalez PharmD,et al.  Use of failure mode, effect and criticality analysis to improve safety in the medication administration process , 2015 .

[32]  David M. Gaba,et al.  Structural and Organizational Issues in Patient Safety: A Comparison of Health Care to other High-Hazard Industries , 2000 .

[33]  David C Mohr,et al.  Teamwork Culture and Patient Satisfaction in Hospitals , 2004, Medical care.

[34]  James P Bagian,et al.  Medical team training: applying crew resource management in the Veterans Health Administration. , 2007, Joint Commission journal on quality and patient safety.

[35]  Julia Neily,et al.  Teamwork and communication in surgical teams: implications for patient safety. , 2008, Journal of the American College of Surgeons.

[36]  K. Roberts Managing High Reliability Organizations , 1990 .

[37]  Patrick D. O'Neil,et al.  Policy and Organizational Change in the Federal Aviation Administration: The Ontogenesis of a High Reliability Organization , 2009 .

[38]  Ellen A. Drost,et al.  Validity and Reliability in Social Science Research. , 2011 .

[39]  Karl E. Weick,et al.  Managing the unexpected: resilient performance in an age of uncertainty, second edition , 2007 .

[40]  Kathryn M. McDonald,et al.  DEVELOPMENT OF NEW HARM-BASED WEIGHTING APPROACH TO COMPOSITE INDICATORS: THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY PATIENT SAFETY FOR SELECTED INDICATORS (AHRQ PSI-90) , 2015 .

[41]  Nicole Adrian Don't Just Talk the Talk , 2009 .