COVID19: High Reliability in Healthcare

A recent webinar hosted by the International Society for Quality in Health Care shared the frontline experiences of Seattle Children’s Hospital in the United States (recording available to watch here).

The organisation’s response to COVID-19 was outlined in areas including:​

• Embedding quality and reliability principles into the execution of a unified response.
• An incident command structure including an Emergency Operations Centre and regular huddles to allow fluidity in response to a changing situation.
• Regular clear and transparent communication of information to and from staff.
• Coordinated management of equipment supplies using a centralised system.
• A COVID-19 dashboard with up-to-date workforce and inpatient data to support planning.
• Effective containment & mitigation strategies including telemedicine in clinics, virtual medical rounds, symptom screening at the door and reduced entrances.

The team referred in particular to Weick et al and the 5 features of high reliability organisations when faced with unexpected situations:

1. A preoccupation with failure – every adverse event or near-miss is analysed and used to drive further improvement.
2. Reluctance to simplify interpretations of issues or risk – resist the tendency to assume causation and recognise the multiple contributing factors of a complex system.
3. Sensitivity to operations – understand the system and its processes from the frontline and recognise that changes to these will occur regularly.
4. Commitment to resilience – persevere despite challenges, acknowledge the commitment of colleagues and continually carry out small tests of change to improve.
5. Deference to expertise – use a multi-disciplinary approach and listen to team members with expertise in a specific process or area of a system rather than assume traditional professional roles.

The application of high reliability principles in healthcare has been studied and much debated over the last decade but it is relevant now more than ever. A literature scan on high reliability organisations in healthcare originally conducted by The Health Foundation in 2011 is available in full here.