Innovation in pursuit of high-reliability culture

The Institute of Medicine sent waves racing across the surface of American healthcare when it published To Err Is Human in 1999. The unsettling report suggested medical errors were killing at least 44,000 and as many as 98,000 patients nationwide each year. Even the lower end of that spectrum would rank such mistakes eighth among leading causes of death—ahead of breast cancer, AIDS, and motor vehicle accidents.

The report challenged the self-perception of modern healthcare personnel and inspired reforms designed to prevent errors or at least catch them before they impacted patients. Ambitious goals were set. But the path forward proved complex, and the fallout from that disturbing report continues to ripple from coast to coast as innovators pursue what has become known as “high-reliability culture.”

Almost every hospital in the country has in recent years pursued initiatives to improve quality and safety in one or more key areas, says Brent Ibata, PhD, JD, MPH, FACHE, research compliance officer for Sentara Healthcare based in Norfolk, Virginia.

“But they’re doing it in what I call a ‘whack-a-mole’ approach,” Ibata says. “There’s very few hospitals that are stepping back and taking it from a cultural perspective.”

Although patient safety advocates have made strides in the past two decades, getting an entire medical staff to embrace high-reliability culture—also known as becoming a high-reliability organization (HRO)—requires a drastic shift in thinking, Ibata says.

“The big picture is we’re making fantastic progress in avoiding the big avoidable things,” Ibata says. “We’re making incremental progress in avoiding the higher-hanging fruit.”

Patric Lundberg, PhD, director of bioinformatics analytics at Eastern Virginia Medical School (EVMS), says nudging along a cultural shift within each hospital is like trying to reroute a number of cruise liners well after they are already in motion. Even if the ships departed from the same port and charted a course for the same destination, turning them requires a great deal of energy at each ship’s local level.

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