Going to the COVID-19 Gemba: using observation and high reliability strategies to achieve safety in a time of crisis

Going to the COVID-19 Gemba: using observation and high reliability strategies to achieve safety in a time of crisis Implementation of high reliability principles in healthcare delivery is recognized as an effective strategy for reducing harm to patients and healthcare workers. 1,2,3 With the COVID-19 pandemic upon us, our emergency departments (EDs) are facing an unprecedented safety threat. How does a high reliability ED function during a pandemic, and what are the most important strategies for keeping ourselves and our patients safe? Historically in medicine, safety was viewed as mostly an individual responsibility, and errors were viewed as human failings. This approach, described by James Reason as the “person approach”, has many shortcomings.4 Importantly, it does not identify and address system issues that predispose to error. Conversely, the “system approach” focuses on understanding the conditions in which individuals work, identifying root causes of errors, and developing defenses. High reliability organizations (HROs) recognize that humans by nature are fallible, and they therefore create systems to recognize failure at early stages and contain damage.4 As individual healthcare providers facing the threat of a deadly pandemic, we seem to inherently recognize that we must rely not only on our individual dedication but more importantly on the reliability of our teams and our systems to prevent unnecessary harm from reaching ourselves and our patients