an HRO involves creating a culture of safety and reliability. This type of culture improves safety, an important element for an effective, efficient health care system. Similarly, a culture of high reliability enhances quality. In addition, a culture of reliability enhances the patient experience. Afterall, what patients or family member is pleased if their care is unsafe or of poor quality? Last, a culture of safety and reliability improves the financial performance of a health care organization.
Much of the early work on safety and high reliability was done in other industries, like commercial aviation and nuclear power. These industries experienced major safety improvements because of their focus on high reliability principles. Health care organizations can apply what has been learned in other safety‐focused industries to improve patient safety.
Regardless of role and setting, nurses must apply the six QSEN competencies to enhance safety. Nursing organizations, interprofessional organizations, government agencies, and accreditation agencies serve as valuable resources when building a culture of safety and high reliability. Nurses are in a strong position to advocate for patient safety and lead interprofessional efforts to achieve high reliability.
KEY CONCEPTS
Errors occur because we are human.
HROs operate under trying conditions but have fewer than expected safety events.
Healthcare has learned a great deal about high reliability from other industries, such as commercial aviation and nuclear power.
Health care organizations on a journey toward high reliability share five characteristics: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise.
The six QSEN core competencies help nurses create a culture of safety and reliability.
Strategic planning is an important step in developing a HRO.
A fair and just culture minimizes blame and punishment and creates a learning environment where errors are reported so that system problems can be corrected.
Organizational culture can be assessed with valid and reliable tools to support a journey toward becoming an HRO.
Professional, governmental, and accreditation organizations provide resources to support the journey toward high reliability.
The components of the Magnet Recognition Program are congruent with HRO concepts.
KEY TERMS
Action plans
Adverse event
Authority gradient
Blunt end
Call‐out communication
Closed loop communication
Comorbidities
Culture of safety
Daily safety huddle
Error
Fair and just culture
Financial performance
FMEA
Hierarchy
HRO
Human factors
Interprofessional
Knowledge‐based performance
Latent errors
Learning organization
Marketing plan
Near miss safety event
Organizational culture
Patient‐centered care
Precursor safety event
QSEN
Quality
Reliability
Root cause analysis
Rule‐based performance
Safety
SBAR
Sentinel event
Serious safety event
Sharp end
Skill‐based performance
Strategic planning
Swiss Cheese model
Teamwork
Transparency
Work‐around
REVIEW QUESTIONS
1 The nurse administers insulin to the wrong patient. The nurse should (select all that apply):Monitor the patient closelyReport the error to the patient's physicianResign from the hospitalComplete an error report
2 A nurse leader makes frequent and regular rounds to nursing units and talks to staff about patient safety. The nurse leader is most likely rounding to:Criticize the safety practices of nurses and other cliniciansLook for weaknesses in the care delivery system that allow errors to occurConduct an FMEARally the troops for the next strategic initiative
3 The delivery of health care is largely based on rules, often called protocol. Nurse leaders need to track data on staff compliance with rule‐based performance because:Nurses frequently experience slips, lapses, and fumblesThis will help them to punish nurses who make errorsNurses forget to double check each other's workThis will help them to look for ways to improve practice
4 The continuous, systematic process of making decisions today with the greatest possible knowledge of their effects on the future is the definition of:Mission, vision, and valuesStrategic planningRoot cause analysisSWOT analysis
5 A just culture creates an atmosphere of trust because it (select all that apply):Never punishes clinicians for their behaviorsEncourages and rewards people for providing essential safety‐related informationViews errors as opportunities to improve health care system risksViews errors as opportunities to improve individual behavioral riskMakes only managers responsible for reporting errorsMakes everyone responsible for identifying safety risks
6 The nurse behaves in one way when her manager and peers are watching and another way when she believes she is not being observed. She is demonstrating:Intrinsic accountabilityHorizontal and vertical accountabilityIntrinsic and horizontal accountabilityVertical accountability
7 An
