Turning Healthcare in to a High Reliability Industry: Memorial Hermann Shares 5 Steps

High reliability industries are everywhere; most people just don't realize it — they range from amusement parks and zoos to oil drilling rigs, air traffic control and nuclear submarines. High reliability is the ongoing safe operation of an organization or entity without a mishap or adverse event. "They have to be high reliability: If they're unsafe, people wouldn't work or go there," says M. Michael Shabot, MD, FACS, FCCM, FACMI, the CMO of Memorial Hermann Healthcare in Houston.

While many organizations and industries classified as high reliability have operated that way for years, the concept has been slow to catch on in the healthcare industry. In healthcare, being a high reliability organization means having no preventable harm incidents and causing no harm to patients. "Hospitals just hadn't thought they could be one," Dr. Shabot says. "We, and other hospitals, are trying to change that."

Dr. Shabot has led the charge for Memorial Hermann to become a high reliability organization through the High Reliability: Journey from Board to Bedside Initiative. After its implementation in 2006, the Board to Bedside Initiative has led to the healthcare system receiving the 2012 John M. Eisenberg Patient Safety and Quality Award in the category "Innovation in Patient Safety and Quality at the National Level" from the National Quality Forum and The Joint Commission.

Root of high reliability

The transformational high reliability program began at the 12-hospital system because the C-suite and board realized change was necessary. "To be honest, the high reliability program grew out of a series of adverse events that occurred in 2006," Dr. Shabot explains. "There was a realization in the system that, in spite of the quality measures [already] undertaken, there was a need to totally change the approach to safety and quality in the healthcare system."

From there, the system's leadership and board developed the high reliability initiative late in 2006.

Steps to high reliability transformation

Since then, the high reliability initiative has grown from being implemented just in Memorial Hermann's hospitals to being used in all of the system's nearly 150 facilities. The following are steps to develop and implement a healthcare high reliability program, based on the formula Dr. Shabot and Memorial Hermann developed.

1. Get the board's support. As the name of Memorial Hermann's initiative suggests, a successful high reliability program has to start with the board.

"Our board members are learning this along with us," Dr. Shabot says. Board members go to safety and quality conferences and take educational courses to learn how to improve patient safety measures. Some board members are even in high reliability industries — the board chair is the CEO of the Houston zoo, for example. Ultimately, the board's support and funding has made the From Board to Bedside Initiative possible.

2. Make patient safety a core value. Many hospitals and health systems have sets of priorities and values, along with a mission statement. Like many other systems, Memorial Hermann has several priorities; however, the system has just one core value: patient safety. "That represented a change," says Dr. Shabot. "Patient safety had been a priority among other priorities." But since 2007, patient safety has been at the heart of everything the system does, which helps promote high reliability.

3. Put employees through a high reliability education program. As part of the program, every single employee — about 20,000 individuals — went through a high reliability educational program off of their job site. "We taught nurses, pharmacists, cooks, maintenance personnel and secretaries, among others, how to do their job safer and ensure the safety of all patients and visitors in our facilities," Dr. Shabot explains. The training program is ongoing, with new-hires also receiving high reliability training upon joining the system.

Through the educational program, employees receive high reliability training and learn techniques from leaders in other high reliability fields, such as airline pilots and nuclear engineers.

4. Follow safety checklists. To prevent various risk events, Memorial Hermann developed safety checklists in departments such as the intensive care unit and the operating room to ensure high reliability and reduce patient risk. For instance, prior to any procedures or surgeries, nurses and physicians run through a checklist with various steps, including verifying the patient's identification, the operation is being performed, the specific body part and materials necessary for the procedure. Additionally, before a blood transfusion or administering a high-risk medication, two licensed providers complete a double-check to ensure safety. Also, all medications are bar-coded and checked against a patient arm band and computerized medication list before they are given.

The checklist system has helped prevent patient harm by eliminating human error and ensuring patient safety.

5. Reward success. Becoming a high reliability organization doesn't just take work from leadership and the board, the success of the initiative relies on every employee in each Memorial Hermann facility. To recognize and reward hospitals and other facilities that embrace the program and achieve excellent results, the system created the High Reliability Certified Zero Award. The award is presented to hospitals that have gone 12 or more months without a patient harm event such as blood stream infections, falls with injuries and other adverse events.

The award certificate is presented with much fanfare at employee gatherings. In the last two years, Memorial Hermann has presented 91 Certified Zero awards.


As a result of the award-winning From Board to Bedside Initiative, the rate of preventable harm incidents in Memorial Hermann's facilities has dropped significantly. For example, since January 2007, more than 775,000 blood transfusions have been given with no transfusion reactions, a vast improvement since 2006. Hospitals in the system have also gone for years at a time without a single pressure ulcer, retained object during surgery or medicine-related safety event, which used to be common, according to Dr. Shabot. And, the hand hygiene program has an audited compliance rate of 92 percent.

Despite the success of the high reliability program, Dr. Shabot says he and the rest of the system cannot rest on their laurels when it comes to patient safety. "The program will never stop. Patient safety is not something you can take your eyes off of or declare, 'we've solved that problem, we can go on to the next one.' Achieving safety is [an] all-day, every-day process," he says. So, the system will continue to strive toward the goal of zero safety events across the system through its High Reliability: Journey from Board to Bedside Initiative.

More Articles on Patient Safety:

5 Steps to Plan an Initiative to Improve Care Across All Settings
4 Best Practices for Safe Patient Handoffs
The Secret to Better Infection Control Compliance: Move Beyond Secret Shoppers

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars