Designing high-reliability healthcare teams

Despite serious and widespread efforts to improve the quality of health care, many patients still suffer preventable harm every day. Hospitals find improvement difficult to sustain, and they suffer “project fatigue” because so many problems need attention. No hospitals or health systems have achieved consistent excellence throughout their institutions. High-reliability science is the study of organizations in industries like commercial aviation and nuclear power that operate under hazardous conditions while maintaining safety levels that are far better than those of health care. A high reliability organization (HRO) is an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity. The definition of a high reliability organization extends beyond patient safety to encompass quality care - and ultimately value. Recommendations and innovations focused on healthcare individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. In addition, an open, transparent, and just culture which would allow a deeper understanding of these factors does not appear to be forthcoming. Adapting and applying the lessons of this science as well as applied human factors thinking to health care offer the promise of enabling hospitals to reach levels of quality and safety that are comparable to those of the best high-reliability organizations. Hospitals can make substantial progress toward high reliability by undertaking several specific organizational change initiatives. Further research and practical experience will be necessary to determine the validity and effectiveness of this framework for high-reliability health care.