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|Issue 157||July 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Implementation of High Reliability Organization Principles
High Reliability Organizations (HROs) are those that "experience fewer than anticipated accidents or events of harm despite operating in highly complex, high-risk environments." At the core of an HRO is a culture of "collective mindfulness," in which all workers look for, and report small problems or unsafe conditions before they pose a substantial risk to the organization. Nuclear power and aviation are classic examples of industries that have applied HRO principles to achieve minimal errors, despite highly hazardous and unpredictable conditions. In February 2019, VA began rolling out the first steps of a nation-wide HRO initiative to improve patient safety, including the establishment of HRO workgroups, performance readiness assessments, and conducting training events and programs.
As death due to medical errors is estimated to be the third leading cause of death in the country, a growing number of healthcare systems are interested in adopting HRO principles.
The use of HRO is designed to change the thinking about patient safety through the following five principles:
This evidence brief sought to systematically evaluate the literature on 1) frameworks for the implementation of an HRO, 2) metrics for evaluating a health system’s progress towards becoming an HRO, and 3) effects of HRO implementation on process and patient safety outcomes. Investigators with VA’s Evidence Synthesis Coordinating Center in Portland, OR reviewed the literature including: Medline®, PsycInfo, CINAHL, and the Cochrane Central Register of Controlled Trials from January 2010 through January 2019. They identified 20 articles published on HRO frameworks, metrics, and evidence of effects.
Summary of Findings
Future HRO implementation research should use quasi-experimental designs, such as natural experiments that deliver HRO interventions at a group of sites with other sites serving as a wait-list control to evaluate the effects of specific intervention components – and to assess the mechanism of change driving outcomes.
Related HSR&D Research Topics:
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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