Nursing And High Reliability in Health Care

This holiday season, I’d like to start by expressing my deepest gratitude to nurses everywhere for their unwavering commitment to excellence and compassion in patient care.

The culture we create at our organizations is essential for setting us up for success, and nurses have an important part to play as we continue our journey to high reliability. I’m proud to be a part of the University of Maryland Medical System, which has very seriously committed to becoming a High-Reliability Organization (HRO). This isn’t just a concept. It is a purposeful shift in how we approach patient care and teamwork, fostering a culture of safety, consistency, and excellence. Team members in High-Reliability Organizations prioritize preventing errors and system failures before they happen. This requires an adjustment in mindset, from reaction-focused, to proactively identifying and addressing potential risks within our systems and processes.

So, what does this mean for nurses?

Nurses constantly anticipate needs, adapt quickly to changes, and collaborate openly and effectively with others on the healthcare team to care for patients. By embracing the principles of HRO, we can further elevate our performance to an even greater level, driving towards an environment where human error is minimized, and we can consistently deliver exceptional patient outcomes. Additionally, HRO empowers team members to voice concerns, provides opportunities for deeper learning and skill development, and creates collaborative and respectful work environments, where unit expertise is key. HRO culture values learning from mistakes. Mistakes and near misses are viewed as opportunities for improvement, analyzed without blame, and used to modify processes.

Here are what I believe to be the key elements of our HRO journey:

1. Proactive Risk Assessment – We must further empower our teams to proactively identify and address potential risks and vulnerabilities in our workflows, processes, and communication systems.
2. Open Communication and Feedback – Transparency and open communication are crucial. A high emphasis on reporting is key – especially encouraging the reporting of near misses, errors, accidents, and concerns without the fear of retribution. Feedback is critical to continuous improvement.
3. Teamwork and Collaboration – Teamwork and collaboration are essential. Effective communication channels and a shared understanding of roles and responsibilities are key to minimizing errors and maximizing patient safety.
4. Continuous learning and improvement – High-reliability organizations are constantly evolving and improving. We will be focusing on ongoing training, education, and opportunities for professional development to reinforce these principles.

Embracing HRO:

As nurses, we enter the profession to help others when they need it most. Nurses care about our patients and each other. We care about patient outcomes and their experience while under our care. We care about teamwork and creating a supportive environment. Nursing participation is essential in shaping a high-reliability culture where our patients can receive the safest, most effective, and most compassionate care. In an HRO culture, nurses are an important component of a larger, more resilient system that proactively seeks ways to prevent errors and improve safety. This results in a culture of continuous improvement and a safer, more effective environment of care and team members who are valued, empowered and motivated to deliver their best work.

To all nurses, thank you for your commitment and dedication to patient safety. I’m delighted to be on this high reliability journey with you.

David G. Hunt, MSN, MBA, RN, NEA-BC

Senior Vice President & Chief Nursing Officer

UM Baltimore Washington Medical Center

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