High Reliability Organizations (HROs) are organizations that invest significant resources to avoid even the small errors that can be expected in the face of highly risky and complex activities. Health-care organizations have adopted high reliability concepts to assure that care provided to patients is safe. While leaders are aware of the importance of high reliability and safety, the level of knowledge and ability to apply these concepts among front-line staff in ambulatory care settings is thought to be low.
In 2010, Johns Hopkins Community Physicians (JHCP) developed a practice safety officer (PSO) program and has conducted monthly online safety training sessions including PSOs and practice managers, who, in turn, are responsible for educating front-line staff. These calls are run by the organization’s Training department, including a Safety Training Administrator, who is a credentialed patient safety expert.
Overall, this “safety council” structure provides a forum for training and knowledge transfer throughout the organization. By 2015, JHCP had more than 40 PSOs; however, some PSOs and managers did not attend this training due to patient care needs. Recent work has further improved this program.
Program Details
In 2015, the Safety Training Administrator gained executive support to assure that PSOs and their managers would be required to join at least 10 of 12 annual calls. In 2016, three new training strategies were introduced into monthly calls:
- Begin by reviewing definitions and the five principles of HROs.
- Use stories to illustrate the relationship between HRO principles and everyday work performed by front-line staff.
- Conclude by asking each PSO to share the “greatest risk” at his or her practice. The greatest risks then are reported monthly to the executive team.
More than 800 person-hours of safety training occurred in fiscal year 2016 and 2017 as a result of this strategy. In FY’17, 46 percent of the practices met the minimum requirement of joining 10 calls.
Results
Of practices whose PSOs joined all 12 calls, 100 percent met the target of 80 percent or higher in JHCP’s Safety Climate survey score.
Overall, JHCP’s 2016 Safety Climate domain increased from 73 percent to 81 percent, the most improved domain for the organization.
