Why It Matters
Angela A. Shippy, a keynote speaker at the IHI/NPSF Patient Safety Congress, shares how established procedures and frequent training can help equip caregivers with the knowledge and skills needed to effectively operate in a crisis.
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High Reliability as a Foundation for Leading Through Disasters

By Angela Shippy | Thursday, May 3, 2018
Hurricane

Health care systems must be ready around the clock to care for patients who are victims of accidents, injuries, and highly infectious diseases. In this post, Angela A. Shippy, MD, a keynote speaker at the IHI/NPSF Patient Safety Congress (May 23–25 in Boston), shares how having established procedures and performing frequent training can help equip caregivers with the knowledge and skill sets needed to effectively operate during times of mass casualty, crisis, or natural disaster.

They say that everything is bigger in Texas, and the devastating effects of Hurricane Harvey, a Category 4 storm, were no exception. More than 50 inches of rain fell on the Greater Houston area, producing widespread flooding across the region and turning hospitals into islands. But as another Texas saying goes, this wasn’t Memorial Hermann’s first rodeo.

In some ways, our teams have been preparing for something like Harvey for almost a decade. Memorial Hermann has sought to achieve high-reliability health care through collaboration of virtually every discipline in the organization. Together, employees, affiliated physicians, and leadership have built an operating model to ensure timely, accurate, and effective treatment for every patient served, with the goal of achieving 100 percent compliance and zero harm.

For example, in 2014, when a patient at a Texas hospital was diagnosed with Ebola, Memorial Hermann responded immediately by developing a more detailed and specific infection control policy. We conducted mock drills in our facilities and initiated training in how to use personal protective equipment. In addition, a foreign travel declaration was implemented as part of the patient screening process across the system with the goal of identifying at-risk patients and avoiding the spread of this highly infectious disease.

These actions built upon the organization’s existing framework designed to ensure the safe management of highly infectious patients across the continuum of care. Additional measures taken also addressed the safety of individuals caring for the patients and reaffirmed the commitment of the health system to protecting its patients, employees, and the community during a time of heightened awareness and media coverage. 

This high-reliability focus, more commonly associated with the nuclear, chemical, and aviation industries, contributes to a culture of safety, where safety is viewed as a shared responsibility and high-reliability behaviors, such as reporting adverse events and near misses, are recognized and rewarded. Memorial Hermann adopted the Robust Process Improvement Program of the Joint Commission Center for Transforming Healthcare, which uses a systematic approach to resolving complex problems using Lean, Six Sigma, and change management practices as well as other methodologies for improving quality and safety. 

Even with a foundation of high-reliability principles established, the journey never stops. Efforts are continuously strengthened through ongoing education, preparation, and training.

In addition to receiving extensive training and participating in drills, Memorial Hermann caregivers remain vigilant through regular simulation exercises designed to practice preparation and response to a patient surge in a controlled and safe environment.

During Tropical Storm Allison we learned that all generators needed to be moved higher and to install submarine doors to decrease the impact of flooding, while Hurricane Rita helped us improve our ride-out and recovery team system to ensure fresh teams were available to care for patients. Those lessons learned better prepared us for Hurricane Harvey as part of Memorial Hermann’s high-reliability culture, thus allowing the system to quickly and effectively respond to the crisis even though no one could have predicted the magnitude of the devastation this unprecedented storm unleashed on the Bayou City.

Each simulated exercise, as well as real-world disasters we have faced, create new opportunities to learn and be prepared for the future. While each situation poses its own unique set of challenges, there are commonalities that have helped Memorial Hermann strengthen its disaster preparedness response.

I am proud of the historic response by our organization, which has served the Houston community for more than 110 years. Memorial Hermann has weathered tragic situations like Hurricane Harvey with resilience and compassion, and proved repeatedly that the organization stands ready and willing to answer the community’s call for help when it comes.

Angela A. Shippy, MD, is Senior Vice President and Chief Quality Officer, Memorial Hermann Health System.

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