A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences
Abstract
Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers’ point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals’ accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals’ current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.
Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety in California hospitals. Qual Saf Health Care 2003;12:112-8.
Leonard MS, Frankel A. Focusing on high reliability. In: leonard A, Frankel A, Simmonds T, eds. Achieving safe and reliable healthcare: strategies and solutions. Chicago: Health Administration Press, 2004:55-75.
Anonymous. Becoming a high reliability organization.James M. Anderson Center for Health System Excellence. (Accessed March 11, 2016, at www.cincinatichildrens. org)
Rochlin GI, Laporte TR, Roberts KH. The self-designing high reliability organizations: aircraft carrier fight operation at sea. Naval War College Rev 1987:76-90.
Roberts KH. Some characteristic of one type of high reliability organization. Organ Sci 1990;1:160-76.
Weick CE. Organizational culture as a source of high reliability. Calif Manage Rev 1987;29:112-27.
Roberts KH, Bea R. Must accidents happen? Lessons from high reliability organization. Acad Manag Exec 2001;15:78.
Roberts KH, Rousseau DM. Research in nearly free, high- reliability organizations: having the bubble. IEEE TransEng Manag 1989;36:132-9.
Weick KE, Roberts KH. Collective mind in organizations: heedful interrelating on flight decks. Adm Sci Q 1993;38:357-81.
Schulman PR. The negotiated order of organizational reliability. Adm Soc 1993;25:353-72.
Bigley GA, Roberts KH. The incident command system: high reliability organizing for complex and volatile task environments. Acad Manag J 2001;44:1281-300.
Madsen PM, Desai VM, Roberts KH, Wong D.Mitigating hazards through continuing design: the birth and evolution of a pediatric intensive care unit. Organ Sci 2006;17:239-48.
Roe E, Schulman PR, eds. High reliability management:operating on the edge. 1st ed. Palo Alto, CA: Stanford University Press, 2008:122-35.
Schulman P. General attributes of safe organizations.Qual Saf Health Care 2004;13:39-44.
Weick KE, Sutcliffe KM, Obstfeld D. Organizing for high reliability: process of collective mindfulness. In: Staw BM, Cummings LL, eds. Greenwich, CT; JAI Press,1999:81-123.
Dargahi H. Quantum leadership: The implication for Iranian nursing leaders 2013; 51(6): 411-417.
Pronovost PJ, Berenhotlz SM, Goeschel CA, Needham DM, Sexton JB, Thompson DA, et al. Creating high reliability in health care organizations. Health Serv Res 2006;41:1599-617.
Dixon NM, Shofer M. Struggling to invent high reliability organizations in health care setting: insights from the field. Health Serv Res 2006;41:1618-32.
Leape LL. Error in medicine. J Am Med Assoc 1994;272:1851-7.
Wilson KA, priest TA, Salas E, Burke CS. Can training for safe Practices reduce the risk of organizational liability? In: Ian Noy Y, Karowski W, eds. Handbook of human factors in litigation. 3rd ed. Boca Raton: CRC press, 2005:6-32.
Rochlin GI. Defining high reliability organizations in practice: a taxonomic prologue. In: Roberts HH ed. New challenges to understand organizations. 1st ed. New York: McMillan Publishing Co, 1993:11-32.
Weick KE, Sufcliffe KM, eds. Managing the unexpected assuring high performance in an age of complexity. San Francisco, USA: Jossy – Bass, 2001:10-7.
Weick KE, Sutcliffe KM, Obstfeld D, eds. Crisis management. Thousands Oak, CA: Sage Publications Inc,2008: 31-36.
Hughes CM, Lapane KL. Nurses and nursing assistants’ perceptions of patient safety culture in nursing home. Int J Qual Health Care 2006;18:281-6.
Vogus TJ, Sutcliffe KM. The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Med Care 2007;45:997-1002.
Baker DP, Day R, Salas E. Teamwork as an essential component of high-reliability organizations. Health Serv Res 2006;41:1576-98.
Leveson, N, Dulac N, Marais K, Carroll J. Moving beyond normal accidents and high reliability organizations: a system approach to safety in complex systems. Organ Stud 2009;30:227-49.
Lashinger HKS, Finegan J. Using empowerment to build trust and respect in the workplace: A strategy addressing the nursing shortage. Nurs Econ 2005;23:6-13.
Tamuz M, Harrison MI. Improving safety in hospitals: contributions of high reliability theory and normal accident theory. Health Res Educ Trust 2006;41:1654-73.
Nemth C, Cook R. Reliability versus resilience: what does health care need? In: Dominguez C, ed. Symposium on reliability in health care. Baltimor, USA: Human factors and Ergonomics Society Annual Meeting Proceedings, 2007:621-5.
Wreathall J. Properties of resilient organizations: an initialvuview. In: Hollnagel, Woods DD, Levenson M, eds. Resilience engineering: concepts and percepts. Hampshire: Ashgate, 2006:275-85.
Saurin TA, Costella MF, De Marcedo Guimaraes LB. A method for assessing health and safety management systems for the resilience engineering perspective. Saf Sci 2009;47:1056-67.
Barker DP, Day R, Salas E. Teamwork as an essential component of high reliability organizations. Health Serv Res 2006;41:1536-98.
Wilson KA, Bunke CS, Priest HA, Salas E. Promoting health care safety through training high reliability teams. Q Saf Health Care 2005;14:303-9.
Weick KE, Sutcliffe KM, eds. Managing the unexpected: resilient performance in an age of uncertainty. 2nd ed. San Francisco, USA: Josscy – Bass, 2007:76-90.
Miller BM, Horsleg SJ. Digging deeper: crisis management in the coal industry. J Appl Commun Res 37. Fredrickson GH, LaPorte TR. Airport security, high reliability, and the problem of rationality. Public Admin Rev 2002;62:33-43.
Xiao Y, Plasters C, Seagull FJ, Moss JA. Cultural and institutional conditions for high reliability teams. Systems, Man and Cybernetics, IEEE Int Conf 2004;3:2580-5.
Downer J. On audits and air plants: reduncy and reliability assessment in high technologies. AccountOrgan Secur 2001;36:269-83.
Holbrook J. The criminalization of total medical mistakes.Br Med J 2003;327:1118-9.
Pietro D, Shyavitz LJ, Smith RA, Auerbach BS.Detecting and reporting medical errors: why the dilemma? Br Med J 2000;320:794-6.
Weismann JS, Annas CL, Epstein AM, Schneider EC, Clarridge B, Kirle L, et al. Error reporting and disclose system. JAMA 2005;293:1359-66.
Carroll JS, Edmondson AC. Leading organizational learning in health Care. Qual Saf Health Care 2002;11:51-6.
Mohr JJ, Abelson HT, Barach P. Creating effective leadership for improving patient safety. Qual Manag Health Care 2002;11:69-78.
Anonymous. National Aeronautics & Space Administration. Colombia Accidont Investigation Board Washington DC, USA: Government Printing office,2003:44-50.
Sexton JB, Thomas EJ, Helmreich RL. Error, stress & teamwork medicine and aviation: cross-sectional surveys. J Hum Perform Extreme Environ 2000;6:6-11.
Zohar D. A group – level model of safety climate: testing the effect of group climate on microaccidents. J Appl Psychol 2000;85:587-96.
Katz-Navan T, Naveh E, Stern Z. Safety climate in health care organizations: a multidimensional approach. Acad Manag J 2005;1075-89.
Sulzer-Azaroff B, Loafman B, Merante R, Hlavacek AC.Improving occupational safety in a large industrial plant:
a systematic replication. J Organl Behav Manag 1990;11:99-120.
Hollnagel E, Woods DD, Leveson N. Resilience engineering: Concepts and precepts. Burliagton, VT: Ashgate, 2006:115-30.
Cooke DL, Rohleder TR. Learning from incidents: from normal accidents to high reliability. Syst Dyn Rev 2006;22:213-39.
Hopkins A, ed. Failure to learn: the BP Texas City refinery disaster. Reprint ed. Australia: CCH Austeralian Limited, 2009:92-110.
Zacharatos A, Barling J, Iverson AD. High performance work systems and occupational safety. J Appl Psychol 2005;90:77-93.
Anonymous. Hospital survey on patient safety culture.Agency for Health care Research and Quality [AHRQ]. Comprehensive database report (AHRQ Publication, No:07-0025); 2007.
Chassin MR, Loeb JM. High reliability health care:getting there from here. Milbank Q 2003;91:459-90.
Anonymous. The ongoing quality improvement journal:next stop, high reliability. Health affairs. (Accessed April 11, 2016, at www.healthaffairs.org).
Quigley PA. Hospital based fall program measurement and improvement in high reliability organizations. Online J Issues Nurs 2013;18:3-8.
Bagnara S, Albolino S, Bellandi T, Tartaglia R. A reporting and hearing culture of medical errors in the health care system. In: Marmaras N, kontogiannis T, Nattaniel D, eds. China: Evete, 2005:5.
Dixon NM, Shofer M. Patterns, culture, and reliability.Health Serv Res 2006;41:1618-42.
Rudman WJ, Bailey JH, Garrett PK, Peden A, Thomas EJ Brown CA. Team work and Safety culture in small rural hospitals in Mississipi. Patient Saf Qual Health Care2006. (Accessed May 12, 2016, at www.psgh.com/novdec06/mississippi.html).
Koenings M, Young L, Adolphs R, Tranel D, Cushman F Hauser M, et al. Damage to the prefrontal cortex increases utilitarian moral Judgement. Nature 2007;446:908-11.
Rizzo A, Ferrante D, Bangara S. handling human error.In: Hoc JM, Cacciabue PC, Hollnagal E, eds. Expertise and technology: Cognition & human computer cooperation. NJ: Erlbaum Hillsdale, 1995.
Garwande A, ed. Complications: a surgeon notes on imperfect science. 1st ed. London: Profile Books,2002:219-80.
Seifert CM, Hutchins EL. Error as opportunity: learning in a cooperative task. Hum Comput Interact 1992;7:409-35.
Frese M. Error management in training: conceptual and empirical results. In: Zucchermaglio C, Bangara S, Sucky SU, eds. Organizational learning and technological change. 1st ed. Berlin: Springar, 1995:201-9.
Robets KH, Stout SK, Halpern JJ. Decision dynamics in two high reliability military organizations. Manag Sci 1994;40:614-28.
Vogus TJ, Sutcliff KM. The safety organizing scale: development and validation of a behavior measure of safety culture in hospital nursing units. Med Care2007;45:46-54.
Roberts K, Desai V, Madson P. Reliability enhancement and demise at Back Bay Medical Center Children's Hospital. In: Carayon P, ed. Handbook of human factors and ergonomics in healthcare and patient safety. London: Erlbaum, 2005:249-58.
Madeson P, Desai V, Roberts K, Wong D. Mitigating hazards through continuing design: the birth and evolution of pediatric intensive care unit. Organ Sci2006;17:239-48.
Stralen Van D. Calderon R, Clements P, Daniel A, Rao R Robert K. High reliability organization methods a facilitate initiation of mechanical ventilation in a pediatric nursing hume. Paper presented at the Society of 35th Critical Care Corgress; San Francisco, California; 2006.
Garavan TN, O'Brien F. The predictors safety climate: a cross-sectional study. IBAR 2001;22:46-57.
Lee T, Harrison K. Assessing safety culture in nuclear power stations. Saf Sci 2000;34:61-97.
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Issue | Vol 54, No 10 (2016) | |
Section | Original Article(s) | |
Keywords | ||
High reliability organizations model Hospital |
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