Wasden Mitchell L
Mitchell L. Wasden, EdD, FACHE, is CEO and executive vice president at Oregon Health and Science University Hospital in Portland. He was formerly CEO of the University of Missouri Health Care in Columbia.
Front Health Serv Manage. 2017;33(4):26-32. doi: 10.1097/HAP.0000000000000009.
WellStar Health System and the Medical University of South Carolina (MUSC), highlighted in this issue's feature articles, are two organizations seeking to drive high reliability by educating leaders and incorporating high-reliability principles into their quality improvement (QI) efforts. The organizations have taken slightly different approaches to executing on high reliability, yet both are encouraged by the apparent success of high-reliability principles in other industries.The high-reliability framework is often applied to healthcare despite the limitations of comparing healthcare organizations to nuclear reactors, commercial airlines, and aircraft carriers. Notably, these industries were classified as "highly reliable" after the fact, meaning their employees and leadership already had existing routines and qualities that researchers would describe, after direct observation, as a shared distinguishing feature. Thus, in contrast to Lean, Six Sigma, and other QI movements that have been applied in healthcare, industries such as nuclear power and aviation came with tools and quantitative processes already embedded. The high-reliability framework is qualitative, while the actual hard, quantitative tools and processes differ by industry. This fact makes adopting high-reliability principles difficult because the tools must be created and scaled for each industry. Healthcare is still in the early stages of building these tools to support the high-reliability framework, and the articles by Saunders and Brennan (at WellStar) and Cawley and Scheurer (at MUSC) describe early attempts to provide insights into launching high-reliability principles and tools in healthcare.High reliability is a theoretical construct that is difficult to implement without a concrete framework for execution. The five characteristics that frame a high-reliability organization (HRO), as outlined by Cawley and Scheurer (citing ), are (1) preoccupation with failure, (2) reluctance to simplify interpretations, (3) sensitivity to operations, (4) commitment to resilience, and (5) deference to expertise. Although these elements point in the right direction, they remain theoretical if not tethered to an organization's operating cycle.
本期专题文章重点介绍的韦尔斯塔健康系统（WellStar Health System）和南卡罗来纳医科大学（Medical University of South Carolina，MUSC），是两家致力于通过培养领导者并将高可靠性原则融入其质量改进（QI）工作来推动高可靠性的机构。这两家机构在执行高可靠性方面采取了略有不同的方法，但高可靠性原则在其他行业的明显成功都激励着它们。尽管将医疗保健机构与核反应堆、商业航空公司和航空母舰进行比较存在局限性，但高可靠性框架仍经常应用于医疗保健领域。值得注意的是，这些行业是事后才被归类为“高可靠性”的，这意味着它们的员工和领导层已经具备了研究人员在直接观察后会描述为共同显著特征的现有常规和特质。因此，与已应用于医疗保健领域的精益、六西格玛和其他质量改进运动不同，核电和航空等行业已经内置了工具和定量流程。高可靠性框架是定性的，而实际的硬性定量工具和流程因行业而异。这一事实使得采用高可靠性原则变得困难，因为必须为每个行业创建并扩展这些工具。医疗保健行业仍处于构建这些工具以支持高可靠性框架的早期阶段，桑德斯和布伦南（韦尔斯塔）以及考利和朔伊雷尔（南卡罗来纳医科大学）的文章描述了在医疗保健领域引入高可靠性原则和工具的早期尝试。高可靠性是一种理论构想，如果没有具体的执行框架就很难实施。考利和朔伊雷尔（引用……）概述的构成高可靠性组织（HRO）的五个特征是：（1）对失败的全神贯注，（2）不愿简化解释，（3）对运营的敏感性，（4）对恢复力的承诺，以及（5）对专业知识的尊重。尽管这些要素指向了正确的方向，但如果不与组织的运营周期挂钩，它们仍然只是理论上的。
