Air travel is the safest mode of transportation in the world, but have you seen the news lately? In 2022, airlines were making front-page news for struggles around cancellations and lost luggage. This year kicked off with much more serious incidents of tarmac and runway mishaps.
In January and February alone, there were two instances of planes contacting each other while taxiing; three episodes in which planes were on a trajectory to collide and evasive actions had to be taken; and one collision between a jetliner and a shuttle bus that injured five people.
These examples can rattle the public’s confidence, but it also has shaken the unwavering infatuation healthcare quality and safety leaders have of that industry. We strive to be like them, yet they, too, are experiencing constraints like staff shortages. Airlines have even petitioned the Federal Aviation Administration to consider reducing training-hour requirements and extending the mandatory pilot retirement age. Luckily, the FAA has not agreed. As healthcare leaders, who do we look to when those industries we try to emulate experience an “in-flight emergency” and drift in their records of success?
For nearly two decades, healthcare organizations have been in pursuit of the elusive status of being a “high reliability organization.” Achieving and sustaining high reliability is an endless endeavor of shaping and embedding a desired culture into an organization—one in which accountability, behavior and performance operate with the highest levels of consistency. When it’s achieved, outcomes (often in the form of reduced harm, errors or defects) are consistently and statistically reliable and best-in-class. For aviation, the highest levels of reliability exist in the key deliverables such as a safe takeoff and landing. Appropriately, this industry places its focus and world-class success on the safety elements of flight than less critical elements, like luggage handling. Personally, I approve of this order of priorities.
How can healthcare leaders proactively respond to signs of drift? Two recent publications suggest safety in healthcare hasn’t achieved near the levels of success and reliability of aviation:
- The Joint Commission found that an increased number of sentinel events were reported in 2022 compared to 2021, with 44% resulting in severe temporary harm.
- The New England Journal of Medicine data from 2018 cites nearly 25% of hospital admissions experienced an adverse event, with nearly 25% of those events being preventable.
Staffing constraints, supply chain hurdles, executive turnover and financial woes all compete for the time and attention of leaders. These distractions cause us to veer just a bit off the runway when it comes to safety.
So, what can we do? In one of my previous organizations, the leadership team was debating the timing of launching training to caregivers and leaders on high reliability principles. One key factor in the decision-making process was considering the stress, burnout and increased workload that teams were already feeling post-pandemic. To quote a dear friend and mentor, “If not now, when? And if not us, who?”
There is no better time than in times of disruption to embed a high reliability culture within your organization. During this preoccupation with where we might be vulnerable, don’t forget to ask those who do the work every day and not just your fellow leaders.
First, be introspective on what consumes your thoughts as a leader on an average day. Write them down and think about what percentage of your daily thought each one consumes. Do the ratios seem appropriately balanced? What percent does safety occupy? Is that enough? Do each of the topics have an undercurrent of reliability within each of them? With this knowledge, we can begin to recognize potential root causes to any drift our organizations are experiencing. Once you identify those root causes, share that information with your peers and strategize on solutions.
Second, evaluate your learning system. Leaders must ensure processes exist that pull together learning from internal and external sources, synthesize those learnings and best practices, and distribute them widely. Membership in ACHE and a patient safety organization is an excellent way to learn from trends, themes and past safety events while enjoying extra protections from discovery. This can be a vehicle to facilitate interprofessional education, share best practices, and collaborate within and outside your organization with others seeking to improve safety.
In addition, partnering with your quality, safety, risk and legal departments on how to package and share safety event data, with an aggressive amount of detail to make it relevant, can help position your workforce to change their own practices based on the experiences of others.
Here are a few other considerations:
- Leaders must fully commit to safety and reliability—not as the only thing to worry about, but as the first.
- Be transparent about risks, vulnerabilities and failures by acknowledging that drift is possible or has already occurred. Be resilient. Then, learn and share learnings.
- Ensure a culture of psychological safety exists in such a way that anyone can report concerns or drift. Learn from workarounds. Tools to assess your culture can be found in many places, including Leading a Culture of Safety: A Blueprint for Success.
- Always be preoccupied with potential failures. Avoid assuming that all is fine until it isn’t.
Despite a few recent missteps, air travel is still the safest form of transportation. Healthcare can continue to study it and eventually become just as safe.
Steve Mrozowski, FACHE, CPPS, is vice president, External Peer Review & Patient Safety, Chartis Clinical Quality Solutions. He also serves as the DEI chair for ACHE of Northern Ohio.