We represent patients injured through medical negligence, but our efforts have the benefit of improving the delivery of care for future patients. It is well known that a significant number of healthcare related adverse events are preventable. We have written quite a bit over the years of safety improvement efforts and organizations oriented towards promoting safer delivery of healthcare. A question that recurs is: how do hospitals effectively prioritize safety? 

To that point, a piece recently caught my eye that discussed high-reliability risk analysis.  

What is high reliability? The Joint Commission defines it as “maintaining consistently high levels of safety and quality over time and across all services and settings.” High reliability organizations (HROs) operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. HROs “work to create an environment in which potential problems are anticipated, detected early, and virtually always responded early enough to prevent catastrophic consequences.” They do so by maintaining “a condition of persistent mindfulness within an organization.” 

High reliability is the norm in aircraft carriers, refineries, nuclear power plants, and space flight command centers, to name a few. Each operate in complex, heavily regulated, and dangerous settings. Why can’t high reliability be the norm in hospitals? 

Presumably each hospital has its own reasons, but a common theme may simply be that doing so is a long and difficult journey that requires a complete overhaul of the hospital’s culture. Many hospitals are still reeling from the seismic shift brought by the COVID pandemic, though some used the crisis to completely overhaul the way they approached patient safety. Systemic changes take time and they certainly require persistence. As such, they require strong leadership at the top and in each department. Empowering all levels of hospital staff to feel a part of the hospital’s safety mission is not an impossible task.