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Zero harm: The journey to high reliability

Establishing a culture of zero harm is critical for organizations that strive to deliver safe, high quality, patient-centered care. Hear how leading healthcare organizations embrace a commitment to making safety a core value.

Video Summary

The commitment to achieving zero harm in healthcare is paramount, recognizing that despite human fallibility, systemic failures rather than individual mistakes are often to blame for serious harm events. Through leveraging data and insights to manage task demands versus resources, safety can be scientifically quantified and managed. The journey towards this goal often begins with a catalyst for change, such as a tragic incident, which then leads to a concerted effort to overhaul the organizational culture towards one that prioritizes safety, quality, and service. Success stories, like the significant reduction in serious safety events at Newmont Health, underscore the importance of a unified approach, leadership commitment, and the continuous, long-term dedication to eradicating harm, thereby engaging all healthcare professionals in this critical mission.

Video Transcript

Zero harm needs to be a priority for every healthcare organization. Our patients come to us assuming that their care is going to be free from harm, and yet we all know that we're human and we are fallible by our nature. Everyone makes errors, period. It doesn't matter how experienced you are, how many degrees you have, how successful you've been in the past, you're a human first, you're an expert second.

So when we've had one of these serious harm events, it's not a single doctor, or a single nurse, or a single misplaced decimal point, it's a failure of the entire system. We have a big advantage in data and insight. If you know about task demands versus resources, and you can manage those mismatches in real time, you can be good in safety. Safety is a science. You can quantify, you can measure, you can analyze it, you can predict it, you can manage it like anything else in your mission. And I think that's what the future is, is to forge those early warning systems into something that leaders do every day.

When we started our safety journey, we certainly talked about the incidents which happened at other organizations. We talked about the incidents that happened in our organization. It really started in 2008, we had an infant death related to a healthcare-acquired infection that we felt like was a preventable situation with that child. When an event such as that happens, I believe you need to use it as a catalyst for organizational change. We took an entire year, worked with our leaders to create a road map on how we were going to eliminate serious harm from our organization. We really had to work hard in getting medical staff and leadership buy-in, along with senior leaders. That's been part of really helping drive safety, which in fact has a halo effect on our quality metrics.

We should combine all those together in one unified culture that's based on safety, quality, and service, using that high reliability platform. Culture is not what you say, it's not what you believe, it's how you act. And more importantly, it's how you act when nobody else is looking. It's through those visible actions of our leaders that the culture begins to change, because the front line, the sharp end, is always watching. The biggest keys to success at Boston Children's Hospital to date is really that our executive leadership and our senior leadership, from the beginning, they've made it be not just a clinical initiative. Having leadership set the direction is critically important.

Find the people with energy and passion to do something new, to do something different. Every Monday, we go out with a story that talks about a near miss or an unsafe condition that one of our associates in one of our 10 hospitals, one of our 200 plus ambulatory centers has brought to us and said, hey, we caught this. This was something that could have harmed somebody, but one of our associates stepped up and really saved the day.

As we were creating the strategic plan, we recognized the old adage that you can't be a prophet in your own land. It would be much more powerful to look for a partner outside the organization who could come in and bring those lessons learned and to help guide us. And the HPI team has been that partner. There's so many different priorities from day to day at a hospital, but it really is trying to establish safety as that core value, that top priority. And I think we have done a really great job. There's definitely a palpable cultural shift in the way we do things around children's health.

Over the course of our engagement with HPI in 2009, Newmont Health has had an 89% reduction in our serious safety events. And I think it's from hitting it through multiple angles, but it's important that the culture had that shift. So all these parts have to fit together. And that's why we talk so much about systems thinking and the socio-technical system. They need to be thinking about the whole thing. What does it add up to? It takes long-term focus to make that change. It's not a program. It's not a project. It's not something you do in one fiscal year. It's a continuous long-term journey to zero.

And when people push back and say that can't be done, ask them, well, is it okay that we then only kill 10 patients a year or maybe only 20? None of us would go there. But when you put out there zero, zero events of serious harm, that engages your clinicians, that engages your physicians, your residents, your students around the journey.

About the author

As a senior advisor in Press Ganey's Strategic Consulting group, Johnson has more than 35 years of experience improving reliability and preventing safety events in nuclear power, transportation, manufacturing and healthcare. Johnson provides guidance on the development of high reliability strategy, curriculum, next level solutions and frameworks and participates in Press Ganey’s value-added high reliability learning series and Safety 2025 Initiative. Johnson was founding partner and chief innovation officer of HPI Consulting where he specialized in designing and implementing human performance reliability programs for large organizations, resulting in dramatically reduced event rates. HPI was acquired by Press Ganey in 2015. Johnson’s background includes root cause analysis for nuclear power events and the Texas A&M bonfire structure collapse, reliability improvement for the U.S. Department of Energy nuclear incident response and manufacturing production at Colorado Fuel & Iron. He has empowered safety culture improvements for more than half the nuclear power plants in the United States. Prior to forming HPI, Johnson was the chief operating officer of Performance Improvement International, technical advisor & assistant engineering manager for the Palo Verde Nuclear Generating Station, and assistant chief test engineer at the Pearl Harbor Naval Shipyard.

Profile Photo of Kerry Johnson