Improving Patient Safety through High Reliability Organizations

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data including process standardization, checks and redundancy, authority migration, communication, and teamwork. The themes uncovered the need for extensive education and training, communication, and teamwork to improve patient safety. The results of the study may be useful to improve safety and enhance leadership to promote a culture of safe patient care. Keywords: High Reliability Organizations, Patient Safety, Subacute Nursing Facility, Case Study Preventable errors in patient care continue to occur despite the efforts of regulators, government, and healthcare organizations. These errors cause harm to patients, and present financial and operational burdens on an organization (Colon-Emeric et al., 2010). The number and impact of errors is astounding. Andel, Davidow, Hollander, and Moreno (2012) reported that over 200,000 deaths occur annually due to medical errors. Between 2003 and 2010, there were 1.04 million medication errors reported to the United States Pharmacopeia MEDMAX system (Schiff, 2015). Researchers estimated an annual cost for preventable errors of nearly $38 billion (Debourgh & Prion, 2012). Additional organizational costs may include staffing, supplies, and litigation. Staff are adversely affected when a patient is harmed, and an organization engaged in unsafe care may experience high turnover (Goh, Chan, & Kuziemsky, 2013; O'Bierne, Sterling, Palacios-Derflingher, Hohman, & Zwicker, 2012). Punitive costs have additionally contributed to the rising cost of healthcare, and some organizations have responded by engaging in defensive medicine (Catino, 2009). Yin (2014) identifies the case study as a tool for exploring a business phenomenon. In a qualitative case study, Yin further states that the results from multiple qualitative studies may be combined to enhance generalizability, as a large sample size does in a quantitative study. In this qualitative single case study, we explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful criterion sampling. We collected data through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data including process standardization, checks and redundancy, authority migration, and communication and teamwork. We begin this paper with the background of High Reliability Organizations. Background Preventable medical harm remains a persistent problem (Diller et al., 2013). Recent changes from the Centers for Medicare and Medicaid (CMS) increases the accountability for errors by restricting financial reimbursement for poor patient care (Knudson, 2013). For example, Medicare discontinued additional payments for certain hospital-acquired conditions that CMS deemed preventable (Lee et al., 2012). Thus, medical providers are at risk if strategies are not in place to address patient safety and quality. Many healthcare administrators and regulators have initiated changes without making significant progress (Diller et al., 2013; Sheps & Cardiff, 2011). However, some administrators have made progress in reducing preventable errors, improving patient safety, and reducing operational costs while complying with regulatory demands. …