Information and analysis are the keys to becoming a high-reliability organization, says Grena Porto, RN, ARM, DFASHRM, senior director of clinical operations at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management. She lists these main components of a high-reliability organization:
• Acknowledgment of risk: Errors always will happen, and they are not shameful, so we can talk about them. Errors are opportunities for learning. Those who make errors can help us to learn from them. The focus must be on detection and recovery.
• Auditing of risk: Effective risk-auditing systems use simple standardized forms, multiple formats for reporting, no confusing or restrictive definitions, no complex terminology, minimal duplication, and anonymity. The auditing program also should focus on information, not data, so that it allows narratives, doesn’t require the reporter to analyze the information, and provides feedback in a "lessons-learned" format. There also should be immediate response to serious hazards.
• Appropriate reward system: Everyone must understand what safety is, and frontline operators must be empowered to act. Rewards must be timely and appropriate, and they must be publicized.
• System quality standards: All participants must know what quality is and everyone must be expected to maintain quality. The quality standards must be based on evidence.
• Flexible management models: Frontline workers are trained and empowered, and the one with the most expertise is in charge. Anyone can make a safety-motivated decision. The goal is management, not micromanagement.
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