Estimated read time: 6 minutes
Within the complex, fast-paced and high stakes world of health care, preventing patient harm must be top of mind for everyone at all points of care delivery. The concept of high reliability challenges health care organizations to make safety the primary priority and be persistent in continuous improvement.
Health care informatics—the integration of health care sciences, computer science, information science and cognitive science to assist in the management of health care information—connects people, processes and technology and can be a powerful tool in the pursuit of a high reliability health care culture.
In this Q&A, Dr. Anwar Mohammad Sirajuddin, associate chief medical informatics officer at Memorial Hermann Health System discusses the principles of high reliability and how informatics can help health systems move toward zero harm.
A proactive approach to patient safety
What does high reliability mean to you, and why is high reliability a core value at Memorial Hermann Health System?
Sirajuddin: High reliability is a state of mind and a conscience process of being proactive in thinking about potential areas of failure. Then, you must make sure steps are in place ahead of time to prevent those failures. At Memorial Hermann, we have a large and diverse patient population. We are dealing with thousands of patients who must go through hundreds, if not thousands, of processes. We must ensure that those processes are repeatable, with as little variation as possible, to provide the best outcomes for our patients and most efficiency for our clinicians.
The role of informatics in achieving zero-harm
How does informatics, the science of processing data for storage and retrieval, support a high reliability environment?
For high-reliability, there are three main things at play—process, people and technology. Informatics are the glue that put these three legs of the stool together. It is the bridge between clinicians and health IT professionals. Informatics allow us to do a deep dive into the intersection of people and processes and then add a layer of technology on top to ensure people are properly following the processes. We have observed over the years that information flow, along with those processes, is key to understanding how we are doing. You see how informatics fits into health care when you get into managing clinical processes using technology.
How does Memorial Hermann validate data to measure success?
We try to understand what success looks like at a high level by evaluating different functional and process measures. When you are thinking about success, you must look at the implementation of new processes and technology and determine if they are being executed properly. How are users interacting with the technology and tools? What are the expected outcomes for clinicians and patients?
Look at all the data that is fed into process and functional measures and come up with thresholds. It is important to understand what the data is and how to transfer those data elements into measures of success. The right way to do that, is to work with clinical stakeholders and clinical experts.
How did Memorial Hermann create the High Reliability Certified Zero Award, and what are some lessons learned?
The High Reliability Certified Zero Award is the brainchild of Dr. Michael Shabot, Memorial Hermann's chief clinical officer. They are based on the theory that hospital acquired infections/conditions and patient safety indicators (e.g. central line-associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, retained foreign bodies and birth trauma) should be events that never happen to any of our patients. From there, we began to apply the "never event" concept to all our patient safety and quality strategies and set a goal of having zero harm over 12 consecutive months.
The Memorial Herman High Reliability Certified Zero Award is presented to hospitals in our system that go a year or longer without adverse events in federally-defined categories. The results are formally certified in monthly reports to the Centers for Medicare and Medicaid Services. Since we started the program in 2011, we have far exceeded this goal with some of our facilities going up to 36 months without having hospital-acquired infections or other conditions that cause patient harm.
Throughout this process, we have learned that zero is an important number. Our High Reliability Certified Zero Award is motivational and proves to non-believers that zero harm is possible.
Committing to zero harm in health care
How do you gain hospital leaders’ support in creating a high reliability culture?
A high reliability culture starts at the board level. When they see it as a priority, there is a trickle-down effect to all our hospital leaders. While leadership plays a big part, it is not enough to only have hospital leaders understand high reliability. It’s a grassroots effort that should touch every single person in the organization. At Memorial Hermann, every employee receives two to three hours of training on creating safe, highly reliable environments for patients. Safety is embedded into our culture and it is everyone’s responsibility.
Even in the informatics domain, we ensure that we thoroughly test all the technology that we build. We understand how it fails and how to fix it. If anyone sees a problem while testing, we don’t brush it aside, we bring it to the attention of everyone. Before we implement any new solution or application, we make sure we have high reliability processes for testing and validation.
What advice would you give to other health care organizations that are trying to achieve high reliability?
Every health care organization will have different focus areas, but across the board, we must provide patients with care that is consistent and has zero variation. If that is the goal, you start to put attention on the areas that you aren’t doing so well in. It’s like having multiple quality improvement projects going on at one time. Leaders must ensure that high reliability processes are in place and people are following those processes. It is also key to have a way to measure data and to identify how to measure success.
High reliability is not a destination, it is a journey. You never stop, you never lose focus on it. You always look for opportunities to improve and have the appropriate data to back up how you are doing.
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