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Creating, executing and sustaining a high-reliability organization in health care

Jennifer Ford (US Department of Veterans Affairs, Washington, District of Columbia, USA)
David B. Isaacks (North Florida/South Georgia Veterans Health System, US Department of Veterans Affairs, Washington, District of Columbia, USA)
Timothy Anderson (VISN 15, US Department of Veterans Affairs, Washington, District of Columbia, USA)

The Learning Organization

ISSN: 0969-6474

Article publication date: 13 February 2024

112

Abstract

Purpose

This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

Design/methodology/approach

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

Findings

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

Practical implications

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

Originality/value

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

Keywords

Acknowledgements

This study received no outside funding or other contributions.

Citation

Ford, J., Isaacks, D.B. and Anderson, T. (2024), "Creating, executing and sustaining a high-reliability organization in health care", The Learning Organization, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/TLO-03-2023-0048

Publisher

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Emerald Publishing Limited

Copyright © 2024, Emerald Publishing Limited

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