Yale New Haven Health System strives to become a high reliability organization

Douglas Vaughn, MD, medical director, Perioperative Services; Rebecca Ciaburri (center), RN, manager, Quality and Safety, Yale-New Haven Children's Hospital; and Katie Testa, RN, director, Quality Improvement Support Services, recently completed training in high reliability organization safety behaviors. They discussed next steps in the HRO project, which include training all YNHH employees on the safety behaviors.
Douglas Vaughn, MD, medical director, Perioperative Services; Rebecca Ciaburri (center), RN, manager, Quality and Safety, Yale-New Haven Children's Hospital; and Katie Testa, RN, director, Quality Improvement Support Services, recently completed training in high reliability organization safety behaviors. They discussed next steps in the HRO project, which include training all YNHH employees on the safety behaviors.

How is a hospital like an airplane? Both are environments where complex, high-risk, high-stakes activities occur, and mistakes can result in very serious injuries or death.

Yet, despite the number of planes in the air every day and inherent risks of flying, the airline industry has very few accidents. One reason is that airlines have adopted the principles of "high reliability organizations," those that have developed specific safety techniques to reduce risk, trained employees to use these techniques, and created an overall culture of safety.

Through the Connecticut Hospital Association, Yale New Haven Health System and other Connecticut health systems and hospitals are working to become high reliability organizations (HROs) and eliminate the preventable errors that can cause patient harm.

The multi-year effort began at YNHHS in 2012 and is being phased in at the different delivery networks. YNHHS is working with a consulting firm called Healthcare Performance Improvement that has helped hundreds of hospitals nationwide successfully become high reliability organizations. Yale-New Haven Hospital recently completed a major step in the HRO process — analyzing past serious safety events. The goal was not to place blame, but to determine what specifically went wrong and how the errors that led to these events could be prevented.

The next step in the HRO process is training all employees and medical staff on safety behaviors that are specific to the health system's needs. One acronym that has been used to illustrate these techniques is CHAMP:

  • Communicate clearly
  • Handoff effectively
  • Attention to detail
  • Mentor each other
  • Practice and accept a questioning attitude

"It's critical to train physicians and all hospital employees, including those in non-clinical areas, on these behaviors," said Thomas Balcezak, MD, senior vice president, Safety and Quality. "The behaviors are simple, but when used consistently, have been proven extremely effective in reducing errors. In some cases, they've helped save lives."

"We're committed to creating a culture of safety," said Alan Kliger, MD, YNHHS vice president and chief quality officer. "Our high reliability work will ensure that employees and physicians are aware of patient safety, and have the tools to prevent errors and eliminate patient harm."