Nr533: quality improvement and patient safety

  In one page, I need to write a Reflective Journal

Reflective Journal – Planning a High Reliability Journey


High Reliability Mindset & Five Principles of High Reliability Organizations

In this video presentation, Frank Federico, BS, RPh, Executive Director, Institute for Healthcare Improvement brings it all together, in other words, the journey to high reliability. Mr. Federico introduces his presentation with the following question: Why do we want to take the journey to high reliability?

Federico, F. (n.d.). Bringing it all together: The journey to high reliability. Barnes Jewish Hospital, Washington University in St. Louis.  (37 min)
NOTE: The link will show a warning in your browser. The CISO of Norwich University has checked and the link is safe to use. Click ‘advanced’ then click button to proceed to video.


Based on Mr. Federico’s presentation, How close or far away is your healthcare organization from the state of high reliability?

 In your Reflective Journal answer the following questions:

  1. How do the characteristics of your own organization compare with the journey to high reliability as described by Mr. Federico.
  2. Describe your organization’s commitment to patient safety and high reliability.
  3. Where does your healthcare organization currently stand on the journey to high reliability?
  4. What is the healthcare organization’s plan or next steps on the high reliability journey?


The Journey to High Reliability

What is foundational?

  • Have clear aims that all can understand and support
    • Creating a world where patients and those who care from them are free from harm. National       Patient Safety Foundation (2014, January)
  • Strategic plan
    • Agree on the path
    • Use an improvement methodology
    • Build capability and capacity
    • Do not forget to engage middle managers
    • Understand the psychology of change
  • Portfolio management
    • Align with organizational aim?
    • Refine, refine and refine
  • Leadership at all layers of an organization
    • Individuals and families are partners in their care
    • Compete on value, with continuous reduction in operating cost
    • Reorganize services to align with new payment systems
    • Everyone is an ‘improver’
  • Design for resilience engineering
    • Learning
    • Responding
    • Monitoring
    • Anticipating
  • Error reduction: Hierarchy of controls
    • Standardization and simplification
  • Improvement methodology
    • Tool kit for improvement, e.g. Lean, Six Sigma, Model or Improvement/PDSA
    • Improvement is a way of life
  • High reliability processes
  • Safer health care through transparency
    • Between clinicians and patients, e.g. disclosure after a medical error
    • Among clinicians, e.g. peer review
    • With the public, e.g. public reporting of safety data
    • Among organizations, e.g. regional collaboratives
  • Teamwork
    • Communications
    • Psychological safety
    • Deference to expertise
  • Situational awareness and huddles

Last modified: Tuesday, February 16, 2021, 4:07 PM

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