Re-examining high reliability: actively organising for safety

摘要: In the 15 years since To Err is Human was published,1 US healthcare industry has worked diligently to improve patient safety. Although progress been made in reducing hospital-acquired conditions2 and, some cases, rates of surgical mortality,3 not achieved broad reductions for most harms. recent years, borrowed ideas from industries that have strong safety records, including teamwork and error reporting aviation, process improvement techniques manufacturing. Healthcare's latest push encourage hospitals become a ‘high reliability organisation’ (HRO).4 HROs maintained remarkable performance despite complex risky work. These ultrasafe organisations never set out be HROs. As Rochlin5 observed: HROs ‘seek an ideal perfection but expect achieve it. They demand complete dread surprise always anticipate deliver take it granted. live by book are unwilling die it’. understand endless journey rather than simple destination. Evidence suggests starting organise higher reliability. Standardised protocols checklists,6 preprocedural postprocedural briefings,7 incident daily huddles,8 although imperfect,9 ,10 may hold promise enhancing safer care. types activities part institution's master plan create comprehensive operating management system—an organisation-wide integrated approach manage risk safe reliable performance—similar systems found other such as oil gas. Yet, we think more likely these efforts represent piecemeal fragmented initiatives adopted solve particular problems. Regardless, high remains elusive. One explanation failed widely institutionalise high-reliability habits …