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Patient Safety Best Practices: Using Socio-cultural Norms to Support the Principles of High Reliability Organizations

We asked Melinda Sawyer, DrPH, MSN, RN, CNS-BC, the Director of Patient Safety and Education for the Armstrong Institute for Patient Safety and Quality for her insight on how healthcare can achieve high reliability. The following is her response.

In order to move healthcare organizations toward higher reliability we must learn from other industries that have achieved this level of reliability. In their book “Managing the Unexpected: Resilient Performance in an Age of Uncertainty”, Drs. Karl Weick and Kathleen Sutcliffe studied organizations that have organized for high performance where the potential for error is overwhelming. Many healthcare leaders are now aware of the five principles for mindful organizing:

  1. A preoccupation with failure
  2. Reluctance to simplify interpretations
  3. Sensitivity to operations
  4. Commitment to resilience
  5. Deference to expertise

What are lesser known are the socio-cultural norms that must be in place to support these five principles. These norms include:

1. Respectful Interactions

To achieve an environment of respectful interactions, all employees from the Board of Trustees to the bedside must engage in behaviors that demonstrate self-respect, trust, and trustworthiness.

Best Practice In Action: During rounds, all members of the multidisciplinary team are asked to identify each patient’s greatest safety risk of the day. As a team, they determine how they will best mitigate that risk.

2. Heedful Interrelations

To achieve heedful interrelations, all employees must understand how they and their role fit into the larger organization. They must understand how they are dependent on others to work within the system and how others are dependent on them.

Best Practice In Action: Create structures within your organization that allow teams that are dependent on each other to understand and improve interdependencies. For example, teams (e.g., the OR, ICU, ED) often work on the safety issues specific to their department or function. By bringing these teams together to work on safety issues they can improve how they work together.

About the Armstrong Institute

The Armstrong Institute for Patient Safety and Quality aims to reduce preventable harm, improve clinical outcomes and experiences and reduce waste in health care delivery at Johns Hopkins and around the world. The institute’s work focuses on:

  1. Eliminating medical errors and complications of care
  2. Enhancing clinical and patient-reported outcomes for all patients
  3. Delivering patient- and family-centered care
  4. Ensuring clinical excellence
  5. Improving health care efficiency and value
  6. Eliminating health care disparities
  7. Creating a culture that values collaboration, accountability and organizational learning

The institute’s work has an impact on patients at Johns Hopkins Medicine, a nearly $6 billion integrated global health enterprise, and beyond.

Learn more here.

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