From the Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan.
Veterans Health Administration, Truman VA Medical Center, Columbia.
J Patient Saf. 2022 Jan 1;18(1):64-70. doi: 10.1097/PTS.0000000000000788.
Applying high-reliability organization (HRO) principles to health care is complex. No consensus exists as to an effective framework for HRO implementation or the direct impact of adoption.
The Veterans Health Administration (VHA) National Center for Patient Safety established the high-reliability hospital (HRH) model for HRO adoption and piloted HRH in collaboration with the Truman VA Medical Center (Truman) during a 3-year intervention period (January 1, 2016-December 31, 2018). High-reliability hospital components are as follows: annual patient safety (PS) assessment, annual PS culture survey, annual root cause analysis training, daily leadership walk-arounds, monthly PS forum, annual processes standardization review, Just Culture training, unit-based Clinical Team Training, unit-based continuous improvement projects, and annual Clinical Team Training simulation education. The impact of HRH was examined using a PS Culture Survey, PS event reporting, and quality outcomes of standardized mortality rate and complication rate.
Truman internally improved PS culture and PS event reporting rates resulting in outcomes better than all VHA facilities (All VHA; P < 0.001 and P < 0.001, respectively). Low-harm PS event reporting increased (P < 0.001); however, serious safety event rate remained unchanged versus All VHA. Significant improvement in Truman standardized mortality rate and complication rate versus All VHA occurred immediately and were sustained through intervention (slopes, P < 0.001 and P < 0.020; respectively).
High-reliability hospital is an effective framework for HRO implementation and will be applied to 18 additional VHA sites. Based on these results, the expected outcome will be improved PS culture and overall PS event reporting. The impact of HRH on serious safety event rate and quality measures requires further study.
将高可靠性组织（HRO）原则应用于医疗保健领域非常复杂。目前，尚不存在关于 HRO 实施的有效框架或采用的直接影响的共识。
退伍军人健康管理局（VA）国家患者安全中心为采用 HRO 建立了高可靠性医院（HRH）模型，并与杜鲁门 VA 医疗中心（杜鲁门）合作，在为期 3 年的干预期（2016 年 1 月 1 日至 2018 年 12 月 31 日）内试行 HRH。HRH 的组成部分如下：年度患者安全（PS）评估、年度 PS 文化调查、年度根本原因分析培训、每日领导巡视、每月 PS 论坛、年度流程标准化审查、公正文化培训、基于单位的临床团队培训、基于单位的持续改进项目以及年度临床团队培训模拟教育。使用 PS 文化调查、PS 事件报告以及标准化死亡率和并发症率的质量结果来检查 HRH 的影响。
杜鲁门内部改善了 PS 文化和 PS 事件报告率，结果优于所有 VA 设施（所有 VA；P<0.001 和 P<0.001）。低伤害 PS 事件报告增加（P<0.001）；然而，与所有 VA 相比，严重安全事件率保持不变。与所有 VA 相比，杜鲁门的标准化死亡率和并发症率立即显著改善，并在干预期间持续（斜率，P<0.001 和 P<0.020；分别）。
高可靠性医院是 HRO 实施的有效框架，将应用于另外 18 个 VA 地点。基于这些结果，预期的结果将是改善 PS 文化和整体 PS 事件报告。HRH 对严重安全事件率和质量措施的影响需要进一步研究。
