Safety culture in healthcare organizations is a fundamental concept to ensure the quality of care and patient safety. With the increasing complexity of healthcare, it is essential to adopt practices and principles that promote a safe and efficient environment. To the High Reliability Organizations (HROs) offer a set of principles that can be applied in healthcare organizations to achieve high levels of safety and reliability.
Healthcare organizations are considered high risk, in the context of HROs, due to factors that directly influence their operations and results. Here are some of the main reasons:
- Critical Nature of the Services Provided;
- Complexity of Operations;
- Dynamic and Unpredictable Environment;
- Diversity of Conditions;
- Human Error;
- Dependence on Technologies;
- Complex Interactions between Multidisciplinary Teams.
Characteristics of a Safety Culture
A strong safety culture is characterized by elements that interrelate to create an environment where patient safety is a priority. Some of the key features include:
- Security Priority: In a safety culture, safety is prioritized in all decisions and actions. This includes resource allocation, training, and development of policies and procedures.
- Open Communication: Clear and open communication is paramount to identifying and resolving security issues. Teams must feel comfortable reporting errors and adverse events without fear of reprisal.
- Continuous Learning: Organizations must be committed to continuous learning and constant improvement. This includes incident analysis, regular audits and implementing evidence-based improvements.
- Engaged Leadership: Visible and engaged leadership is fundamental to promoting and maintaining a culture of safety. Leaders must demonstrate a commitment to safety and inspire their teams to do the same.
- Fair Accountability: A culture of fair accountability recognizes that most errors result from systemic failures rather than individuals. Organizations should focus on improving systems and processes rather than punishing team members.
Principles of HROs
HROs are organizations that operate in complex, high-risk environments but manage to maintain consistently low levels of accidents and errors. Five fundamental principles guide these organizations:
- Concern about Failures: HROs are constantly vigilant to identify and correct small flaws before they become major problems. This involves creating a culture where errors are reported and analyzed in detail.
- Reluctance to Simplify: Rather than seeking simplistic solutions to complex problems, HROs recognize the complexity of their operations and seek to fully understand it before taking action.
- Sensitivity to Operations: HROs maintain high situational awareness, ensuring that all team members are aware of actual working conditions and potential hazards.
- Commitment to Resilience: Resilience is the ability to respond quickly and effectively to unexpected events. HROs train their teams to be adaptable and prepared to deal with unexpected events.
- Valuing Experience: When problems arise, HROs rely on the most knowledgeable experts, regardless of their hierarchical position, to make critical decisions.
Contribution of HRO Principles to Safety Culture
The principles of HROs are essential for building and maintaining a culture of safety in healthcare organizations. These principles promote continuous vigilance to detect and correct failures before they cause harm, encourage detailed and comprehensive incident analysis, develop the ability to respond quickly and effectively to emergencies, and value the specialized knowledge of professionals. Table 1 shows the main contributions.
Table 1: Contributions of HRO principles to safety culture
| Principles of HROs | Contributions to Safety Culture |
|---|---|
| Concern about Failure | Implement continuous monitoring systems to detect problems before they worsen, promoting a culture of constant vigilance. Encourages the reporting of incidents and near misses without fear of reprisal, creating an environment where professionals feel safe to report problems and collaborate in finding solutions. |
| Reluctance to Simplify | Promotes detailed and comprehensive incident analysis to identify all possible causes, avoiding superficial solutions. Encourages the participation of multidisciplinary teams in analyzing problems, ensuring that multiple perspectives and expertise are considered. |
| Sensitivity to Operations | Implements regular security monitoring, where leaders observe and discuss practices with the team, identifying potential risks in real time. It uses monitoring technologies to maintain constant surveillance over performance and security indicators, allowing quick responses to any anomalies. |
| Commitment to Resilience | Provides regular training in resilience and emergency response, ensuring that all employees know how to act in critical situations. Develops and regularly tests contingency plans for various failure situations, ensuring that the organization can maintain continuity of care even under adverse conditions. |
| Valuing Experience | Establishes decision frameworks that enable experts to make quick decisions during emergencies, improving the accuracy and effectiveness of responses. Promotes a culture where expertise is respected and valued, encouraging cooperation between different hierarchical levels and specialties. |
Studies show the positive results achieved by healthcare organizations after adopting the principles of HROs. The article Evidence Brief: Implementation of High Reliability Organization Principles highlights significant reductions in serious safety events, ranging from 55% to 100%. For example, the Ohio Children's Hospital Association achieved a 55% reduction in serious safety events, while Nationwide Children's Hospital achieved an 83% reduction after two years of implementing HRO principles.
Conclusion
Adopting the principles of HROs promotes an environment where patient safety is prioritized and maintained. By integrating concerns about failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and valuing experience, healthcare organizations can achieve high levels of safety and quality of care. Implementing these principles, supported by engaged leadership and open communication, creates a solid foundation for a sustainable and effective safety culture.
Author: BIGOLIN, Fernanda. PhD in Information Technologies and Systems, writer, specialist in the practices and principles of High Reliability Organizations (HRO) and interoperability in healthcare.
