High-reliability healthcare: Bridging the trust gap through information technology
Why it’s key to harness the power of HIT to achieve high reliability and patient safety, gained in lessons from other high-reliability organizations.
There are certain organizations that we rarely think about, not because they are unimportant, but because we have faith that they will operate error-free. For example, we don’t expect airplanes to drop out of the sky. We believe air traffic control is so tightly controlled and so perfectly practiced that an accident is almost unimaginable.
Other organizations are similar. We trust them because they operate, as they must, with no margin for error – power plants, space flight command centers, nuclear submarines, chemical processors. To this list of domains where high reliability is critical because the consequences of error are great, we would like to add healthcare organizations.
But healthcare organizations are not viewed with quite the same degree of confidence. Even though they are committed to being so, their error rates remain high.
In a study published by the New England Journal of Medicine in January, 2023, the researchers reported the frequency, preventability and severity of patient harm in a random sample of admissions during the 2018 calendar year. They identified an adverse event in nearly one quarter of the cases. More than 20 percent of these were judged to be preventable and 32.3 percent were judged to be serious. There were seven deaths, one of which was deemed preventable. Adverse drug events accounted for 39 percent of all events, followed by surgical or procedural events, patient care events and infections.
In short, “adverse events were identified in nearly one in four admissions, and approximately one fourth of the events were preventable. These findings underscore the importance of patient safety and the need for continuing improvement.” These findings also demonstrate why healthcare organizations do not enjoy the same degree of trust as other high reliability organizations.
In response, healthcare providers have studied the principles and practices of high-reliability organizations that have been applied by industries perceived as error-free and are emulating and adapting them in their own practices.
The nature of high-reliability organizations
A key characteristic of high-reliability entities is a prevailing consciousness of their organization’s intricacies, its complexities, and the ways in which it interacts with human fallibility.
In other words, it is understood in HROs that humans make mistakes, so their systems and processes are designed to limit the likelihood of those mistakes. They do this by attending to where humans are vulnerable to error, taking advantage of where humans can apply their strengths, and fostering a culture where preventable defects are discussed and addressed systemically.
Another way of looking at this campaign to make healthcare more reliable is to think about organizations anthropomorphically. They have characteristics much the same as individuals, one of which is the capacity for flexibility, which the American Medical Association defines as the ability to pivot when new and unexpected challenges arise and to absorb unexpected shocks that cannot be avoided even with proper planning. When leaders establish effective structures, protocols and behaviors to achieve overall organizational resilience and close the gap for when crisis occurs, they create high-reliability organizations, says the AMA.
What would this look like in practice? In some organizations that have adapted this way of thinking, there are daily leadership check-ins to discuss safety events and risks that may have occurred in the previous 24 hours. Leaders work with their teams to examine the structural issues that arose, follow up on previously identified issues and communicate which changes are necessary to execute. This process reduces the amount of energy expended to establish a team communication process in the middle of the crisis. It’s a prime example of organizational resilience and a way to achieve the highest possible level of safety.
It's all about the data
However, this only describes the prescriptive characteristics of HROs. No organization can achieve high reliability unless the proper information is at hand.
The NEJM analysis of preventable incidents called out the considerable variability among hospitals where adverse events occurred. In particular, the findings showed that larger sites had rates approximately 40 percent or more than smaller organizations. The authors suggest that if hospitals could obtain and rely on more data more routinely collected, monitoring would improve, adverse event rates would be reduced and improvement strategies more easily shared through careful study of interventions.
As healthcare organizations strive to provide the highest quality care while navigating complex regulatory environments, the role of healthcare information technology (HIT) in achieving these goals is becoming increasingly critical.
High reliability organizations prioritize safety, resilience, and continuous improvement, making them well-suited to address the challenges of patient safety in healthcare. HIT can play a pivotal role in transforming healthcare organizations into HROs by streamlining processes, reducing errors, and fostering a culture of safety.
One of the key components of high reliability in healthcare is the integration of advanced technologies, such as electronic health records (EHRs), telemedicine, and remote patient monitoring. These technologies not only improve efficiency and communication among healthcare providers but also empower patients to take an active role in their care. By providing patients with access to their medical records and facilitating shared decision-making, HIT can help create a more transparent and patient-centered healthcare system.
High-tech’s role
Data analytics and artificial intelligence (AI) are also playing an increasingly important role in patient safety. By leveraging these tools, healthcare organizations can identify patterns and trends in patient safety data, enabling more informed decision-making and targeted interventions. For example, predictive analytics can help identify patients at risk for adverse events, enabling healthcare providers to take proactive steps to prevent harm.
Another critical aspect of high reliability in healthcare is the standardization of processes and protocols. HIT can support the implementation of standardized clinical guidelines, checklists and handoff procedures, reducing variability in care and promoting consistent, high-quality practices. Furthermore, the use of simulation-based training, enabled by virtual reality and other immersive technologies, lets healthcare providers hone their skills and decision-making in a controlled environment, ultimately improving patient safety.
Collaboration and teamwork are essential for achieving high reliability in healthcare. HIT can facilitate interdisciplinary communication and collaboration by providing a centralized platform for sharing information and best practices. This fosters a culture of open communication and mutual respect among healthcare providers, which is vital for improving patient safety.
Lastly, addressing healthcare worker well-being is crucial for ensuring patient safety. HIT can play a role in reducing burnout and promoting work-life balance by streamlining workflows and automating repetitive tasks. By supporting healthcare providers' mental health and well-being, HIT can contribute to improved patient safety and care quality.
In conclusion, healthcare information technology has the potential to transform healthcare organizations into high-reliability organizations that prioritize patient safety. By integrating advanced technologies, leveraging data analytics and AI, standardizing processes, fostering collaboration, and supporting healthcare worker well-being, HIT can play a pivotal role in shaping the future of patient safety in healthcare.
As the industry continues to evolve, it is essential for healthcare organizations to embrace these advancements and prioritize the safety and well-being of their patients.
Justin Campbell is vice president of Galen Healthcare Solutions, an RLDatix company.