Running head: HIGH RELIABILITY ORGANIZATIONS ASSIGNMENT

HighReliabilityOrganizationsAssignment
MariahDelaire
HCA622
February20,2016
ProfessorCourtneyJohnson

HIGH RELIABILITY ORGANIZATIONS

2
Abstract

HighReliabilityOrganizations(HROs)areorganizationsthatstrivetoachievezerodefects
byusingsystemsandprocessesthatconsistentlyaccomplishgoals,andavoidpotential
consequentialandcatastrophicerrors.HROsarefairlynewtothehealthcareindustry,butwere
firstembracedbyorganizationswhosefailuresledtocatastrophe,suchasairplanecrashes,
nuclearreactormeltdowns,andotherdisasters(Hines,Luna,&Lofthus,2008).Thesetypesof
industriesfeltitnecessarytoidentifyweaknessesintheiroperations,andrespondstronglyso
disasterscouldbemaintainedandavoided.Thispaperfocusesondeterminingwhatahigh
reliabilityorganizationis,andelaboratingonhoworganizationscanachievehighreliability
status.TobetterexplainhowaHROisformed,JohnsHopkinsHealthSystemisusedasan
exampleduetotheirTopPerformerstatusgrantedtothembyTheJointCommission.

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HighReliabilityOrganizationsAssignment
CharacteristicsofHROs
CommoncharacteristicsthatHighReliabilityOrganizationsholdisthattheyprioritizesafety
andperformancewhilehavingsharedgoalsacrosstheorganization.Theyalsoestablishacultureof
reliabilitythatisbothcentralizedanddecentralizedthroughoutoperations,allowingdecisionsto
extendoutsideofexecutiveleadershipandtowardslowerrankingemployees(Chassin&Loeb,
2013).HROsalsousetrialanderrorlearningprocessestohelpchangeforthebetterifaccidents,
incidents,andnearmissesoccur,allowingmemberstobetteradjusttotheseissues(DavedVan
Stralen,2013).Itisessentialthathealthcareorganizationsensurereliabilityinordertoprovidethe
bestqualitycaretotheirpatients,andpreventmedicalerrorsandinefficiencies.
WhatimpactdoHROshaveonthehealthcareindustry?
Highreliabilityorganizationshavemanypositiveeffectsonthecurrenthealthcareindustry
inmanyways.HROspromoteanenvironmentofcollectivemindfulnesswhereemployees
constantlylookandreportsmallproblemsoranyunsafeconditionsbeforetheybecomearisktothe
organization(Chassin&Loeb,2013).DuetothefastactingnatureofHROemployees,organizations
rarelyhaveaccidentsthatleadtocatastrophicevents.Theyalsoutilizeanyinformationgainedfrom
identifiederrorsorclosecalls,andcananalyzetheeventstopinpointspecificweaknessesinsafety
andprocedurestohelpreducefuturerisk(Chassin&Loeb,2013).
Medicalerrorsareamajordefecthospitalstryandavoid,butwithoutsystemsandprotocols
inplace,therearenorealwaysofavoidingthem.Highreliabilitymodelsreducemedicalerrorsand
continuouslyimprovethequalityofcaretheygivetopatients.Theadvancesinhealthinformation
technology(HIT)havehelpedcontributetohighreliabilityaswell.HIThasallowedhospitalsto

HIGH RELIABILITY ORGANIZATIONS

bettermonitortheirsystemsofcare,medicationdispending,andtheamountofsystemwaste(Hines,
Luna,&Lofthus,2008).AlongwithreducingmedicalerrorsandtheuseofHIT,highreliability
demandstotalqualitymanagementandcontinuousqualityimprovementwiththeuseof
methodologiessuchasSixSigmaandLeanThinking(Hines,etal,2008).Withoutcontinuously
tryingtoachievezerodefectsandimprovequality,hospitalswouldfailtomeettheneedsoftheir
patients.
JohnsHopkinsHealthcareSystem:AHighReliabilityOrganization
JohnsHopkinsMedicine(JHM)isahealthcaresystemthatcomprisesofsixacademicand
communityhospitals,foursuburbanhealthcareandsurgerycenters,andmorethan30primary
healthcareoutpatientclinics(JohnsHopkinsHealthSystem,2016).ThreehospitalsintheJohns
HopkinsHealthcareSystemhavebeennamedTopPerformerbyTheJointCommissionforkey
qualitymeasures.Hospitalswhoconsistentlyfollowbestpracticesfortreatingpeoplewhorequired
surgery,heartattacks,heartfailure,stroke,pneumonia,andotherseriousconditionscanbe
recognizedasaTopPerformer(JohnsHopkinsMedicine,2016).
WhatMakesJohnsHopkinsHighlyReliable?
In2011,JohnsHopkinsHealthSystemcreatedtheArmstrongInstituteforPatientSafetyand
Quality.Thegoalofthisinstitutewastoaccommodatetheprocessofimprovingqualityandsafety,
advancingthescienceofimprovement,implementimprovementprogramsandsupportsystems,and
createaculturethatsupportslearningandaccountability(Pronovost,Demski,&Callender,2013).
AnextendedgoaloftheArmstrongInstituteistopartnerwithpatientsandtheirlovedonesto
eliminatepreventableharm,improvepatientoutcomesandexperience,andreducehealthcarerelated
waste(Hines,2008).InordertobenamedaTopPerformerbytheJointCommission,atleast95%of

HIGH RELIABILITY ORGANIZATIONS

patientsmustreceivetherecommendedtherapiesfortheaccountabilitymeasure.Toachievethis,
JHMsetagoalof96%toensurepatientsreceivedtherecommendedcare.
TheArmstrongInstitutecreatedaconceptualmodeltoaddressanychallengesthatmay
accompanyqualityandsafetyinitiatives.Thismodelincludedclarifyingandcommunicatinggoals
thatmeasureacrossalllevelsoftheorganization,buildingcapacityusingtheLeanSigma
methodology,education,andclinicalcommunities,reportandensureaccountabilityforperformance,
anddevelopasustainabilityprocess(Pronovost,Demski,2013).JohnsHopkinsHospital(JHH)
ensuredpatientsalwaysreceivedthebestcarebyforming40multidisciplinarygroupsacrossthe
healthsystem.Eachgroupwasmadeupofafacultymemberandaqualityimprovementcoachfrom
theArmstrongInstitute.Thefacultymemberswereexpertsinpatientsafetyandthecoachestrained
inSixSigma,allowingformoreefficientprocessestooccur(JHM,2016).Theuseoftheconceptual
modelassistedJohnsHopkinsHospitaltosignificantlyimproveitsperformanceonthe
accountabilitymeasure,whichallowedthemtomeetthespecificcriteriaforTopPerformer.The
goalsandinitiativesthatJohnsHopkinsHealthSystemsetallowedforqualityandoverall
performancetoimprove,whilecreatingasystemwithlessinefficaciesandbetterpatientoutcomes.
Conclusion
Theimplementationofhighreliabilityprocessesinorganizationsisessentialtoproviding
efficientandqualitycarewithlittledefects.Todayshealthcaresystemfocusesmoreonthequality
ofcarepatientsarereceiving,andinordertobetteraccommodatetheirneeds,hospitalsneedtofocus
oneliminatingdefects.JohnsHopkinsisanexemplaryexampleofhowhospitalscanachievethis
status.Ifmoreorganizationsfollowtheirmodel,thenwewillliveinasystemwithlittlehealth
relatederrorsandhighqualitycareforeveryone.

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References
Chassin,M.R.,&Loeb,J.M.(2013).HighReliaibiltyHealthcare:GettingHerefromThere.
OakbrookTerrace,IL:TheJointCommission.
DavedVanStralen,M.(2013).ModelsofHRO.RetrievedfromHighReliabilityOrganizing:
http://highreliability.org/HighReliabilityOrganizations
Hines,S.,Luna,K.,&Lofthus,J.(2008).BecomingaHighReliabilityOrganization:
OperationalAdviceforHospitalLeaders.Rockville,MD:AgencyforHealthcare
ResearchandQuality.
JohnsHopkinsHealthSystem.(2016).TheJohnsHopkinsHospitalandHealthSystem.
RetrievedfromJohnsHopkinsMedicine:
http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/jhhhs.html
JohnsHopkinsMedicine.(2016).ThreeJohnsHopkinsMedicineHospitalsNamedTop
PerformersinQualityandSafety.RetrievedfromJohnsHopkinsMedicine:
http://www.hopkinsmedicine.org/news/stories/johns_hopkins_medicine_hospitals_named
_top_performers_quality_safety.html
Pronovost,P.J.,Demski,R.,&Callender,T.(2013).DemonstratingHighReliabilityon
AccountabilityMeasuresatTheJohnsHopkinsHospital.TheJointCommissionJournal
onQualityandPatientSafety,531544.

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Ransom,E.R.,Joshi,M.S.,Nash,D.B.,&Ransom,S.B.(2008).VariationinMedicalPractice
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