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What is a High Reliability Organization (HRO)?
An organization that achieves nearly failure free results despite the presence of serious hazards arising from the basic nature of its work
What is the Objective of the APSF HRO project?
To learn how to apply HRO concepts to peri-operative care as one approach to reducing adverse events.
To use HRO concepts to move toward the goal of zero defects, meaning that no patient is injured during the peri-operative experience
What are the current HRO Project activities?
The HRO Project was initiated at the APSF Annual Workshop in October 2003. The key recommendation arising from that meeting was to organize one or more demonstration sites. These would involve hospitals or organizations that will be a learning team to identify core principles and methods to move organizations toward safer models of patient care guided by HRO concepts. A team of four hospitals was convened and began working on developing a tool to establish what are HRO characteristics that each could assess of themselves.
The immediate aim we established was to develop a tool that can be applied at the level of micro-systems in hospitals. The rationale is that real change happens most effectively at the local level and especially via the efforts of local leaders, perhaps enabled by institutional resources.
The Society for Critical Care Medicine - SCCM (http://www.sccm.org) joined APSF as a supporting organization just after the APSF workshop. We assembled a set of HRO characteristics taken from the various models described in the literature. We then decided to use a process similar to that used for the Malcolm Baldrige National Quality Award (http://www.quality.nist.gov/), which are given to applicant corporations for achieving a demonstrated high level of excellence in their business. The organization must follow a proscribed path to demonstrate how it achieves excellence in a number of specific areas. The HRO principles were mapped onto a Baldrige framework that became a tool for assessing a micro-systems adherence to those principles. The tool was developed and piloted by Abington Memorial Hospital. The initial version was revised to be more user-friendly and web-based. It was distributed to the other organizations for trials to use in whatever way fit their local needs. One organization dropped out after the team leader left. Another is only in the earliest stages of use of the tool. Abington and one other have applied the tool and reported on their experiences at the Annual Congress of the National Patient Safety Foundation on May 16, 2008. The slides from those two presentations are linked below.
Abington Hospital HRO Initiative
Texas Tech HRO Initiative
Article on the APSF/SCCM HRO Collaborative
Where can you find more information about HRO theory and applications?
APSF Newsletter articles on HROs:
http://www.apsf.org/resource_center/newsletter/2004/summer/11hro.htm
http://www.apsf.org/resource_center/newsletter/2003/spring/
http://apsf.org/resource_center/newsletter/2003/spring/hrohistory.htm
Slides from the APSF HRO workshop
Report of the APSF HRO workshop
http://apsf.org/resource_center/newsletter/2003/winter/13HRO.htm
References about non-healthcare HROs
See lists in APSF Newsletter articles in links above.
Project Team
Jeffrey Cooper, PhD Chair Massachusetts Gen. Hospital
Ralitsa Akins, MD Texas Tech Medical School
Peter Angood, MD Joint Commission
Gail Carlson, Univ. of Mississippi Med. Center
Ruth Fanning, MB Stanford U. School of Medicine
Maureen Frye, RN Abington Hospital
Dave Gaba, MD Stanford University School of Medicine
Jack Kelly, MD Abington Hospital
Barret Kitch, MD Brigham & Womens Hospital
Nancy McMahon, RN Community Memorial Hospital
Mike Rosenblatt, MD, MPH Lahey Clinic Medical Center
Sara Singer, PhD Harvard School of Public Health
Susan Tierney-Tutor, Univ. of Mississippi Med. Center
Michael Winniford, MD Univ. of Mississippi Med. Center
Support staff
Lori Harmon (SCCM), RRT, MBA Society of Critical Care Medicine
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