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A case of the birth and death of a high reliability healthcare organisation.

High reliability organisations (HROs) are those in which errors rarely occur. To accomplish this they conduct relatively error free operations over long periods of time and make consistently good decisions resulting in high quality and reliability. Some organisational processes that characterise HRO...

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Published in:Quality & Safety in Health Care pp. 216 - 221
Main Authors: Roberts KH, Madsen P, Desai V, Van Stralen D
Format: tables/charts Journal Article
Published: BMJ Publishing Group Jun2005
Online Access:View this record in EBSCOhost
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      dt: Jun2005
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      pub: BMJ Publishing Group
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        106546623
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        10.1136/qshc.2003.009589
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        atl: A case of the birth and death of a high reliability healthcare organisation.
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        au:
          Roberts KH
          Madsen P
          Desai V
          Van Stralen D
        affil: Walter A. Haas School of Business, 545 Student Services Building, University of California, Berkeley, CA 94720; Karlene@haas.berkeley.edu
      sug:
        subj:
          Authority
          Organizational Change
          Organizational Structure
          Patient Safety
          Treatment Errors Prevention and Control
          Infant
          Intensive Care Units, Pediatric
          Process Assessment (Health Care)
          Infant: 1-23 months
      ab: High reliability organisations (HROs) are those in which errors rarely occur. To accomplish this they conduct relatively error free operations over long periods of time and make consistently good decisions resulting in high quality and reliability. Some organisational processes that characterise HROs are process auditing, implementing appropriate reward systems, avoiding quality degradation, appropriately perceiving that risk exists and developing strategies to deal with it, and command and control. Command and control processes include migrating decision making, redundancy in people or hardware, developing situational awareness, formal rules and procedures, and training. These processes must be tailored to the specific organisation implementing them. These processes were applied to a paediatric intensive care unit (PICU) where care was derived from problem solving methodology rather than protocol. After a leadership change, the unit returned to the hierarchical medical model of care. Important outcome variables such as infant mortality, patient return to the PICU after discharge, days on the PICU, air transports, degraded. Implications for clinical practice include providing caregivers with sufficient flexibility to meet changing situations, encouraging teamwork, and avoiding shaming, naming, and blaming.
      pubtype: Academic Journal
      doctype:
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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