4 steps for transforming to a high-reliability organization

At the Becker's Hospital Review CEO Strategy Roundtable in Chicago on Nov. 5, Charles Stokes, COO of Houston-based Memorial Hermann Health System, and M. Michael Shabot, MD, the system's CMO, discussed the necessary components of starting and sustaining the transformation to becoming a high-reliability organization from an executive and administrative standpoint.

First and foremost, organizations should set out on the journey to becoming an HRO because it is the right thing to do for the patients they serve, according to Mr. Stokes. HROs also have higher public accountability. "Accountability is really here today and will only become more and more stringent in the future. Transparency of the quality of data is out there and available," he said.

Also, quality is directly tied to reimbursement rates, so hospitals have additional financial incentives to improve. Another critical factor driving healthcare organizations to become HROs is the current rate of adverse events and deaths resulting from medical errors. "Our healthcare system is harming and killing patients at an unacceptable rate," Mr. Stokes said.

Four steps in the transformation process to becoming an HRO are outlined below, according to Mr. Stokes and Dr. Shabot.

1. Gain higher commitment from the organization's governance. Making sure the organization's governance has made efforts to becoming an HRO a priority is critical for a successful transformation, according to Mr. Stokes and Dr. Shabot. This can be achieved by dedicating substantial time to discussing quality at board meetings.

2. Toughen up credentialing and re-credentialing processes. According to Dr. Shabot, credentialing and re-credentialing processes have been far too lax in many hospitals across the U.S. At Memorial Hermann Health System, all healthcare professionals are required to take training modules as part of their re-credentialing process that aim to help them adopt best practices and handle emergencies to improve overall quality.

Since implementing these mandatory modules, Memorial Hermann has experienced far fewer adverse events, even achieving zero events for multiple consecutive years in certain categories.

3. Develop evidence-based protocols. Showing serious safety event summaries at board meetings is an effective way of having healthcare professionals and board members face the number of adverse events that occur in their organization.

Mr. Stokes said at monthly board meetings, the safety event summaries from the previous month are shown, including patients' names, the event that occurred and if the event caused death. According to Mr. Stokes, showing these reports resonated with board members and also weighed on their decisions when it came time for re-credentialing physicians who have serious medical errors.

"When you shine a light on something, things have a tendency to improve," he said.

4. Make safety a core value. Moving the organization's perception of safety from just a value to a core value is critical, according to Mr. Stokes. When safety becomes a core value, there is a different leadership and expectations, he said.

The principles of an HRO should be embedded into the organization's culture as well. Patient safety is everyone's responsibility; hardwiring it into the culture will lead to sustainability of the results and long-term improvement.

5. Think: "STAR." According to Dr. Shabot, if physicians and nurses stop, think, act and review before making a decision, medical errors and adverse events are less likely to occur.

"We ask everyone to take one second to stop and think. They should ask themselves questions like is this the right patient? Dose? Time?" he explained. Just a few seconds of pause and thought correlate to a lower probability of error, according to Dr. Shabot.

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