WIHI: Highly Reliable Hospitals: The Work Ahead

Date: March 8, 2012


  • Maureen Bisognano, President and CEO, Institute for Healthcare Improvement
  • Mark R. Chassin, MD, FACP, MPP, MPH, President, The Joint Commission and the Joint Commission for Transforming Healthcare

How many patient safety goals does it take to get the US health care system to function as safely and as reliably as it should? And, looked at through the lens of the Joint Commission’s program for hospitals, can 15 broad goals covering patient identification, medication safety, infection prevention, surgical error prevention, communication, and prevention of patient suicide add up to the safe and effective care that must become a hallmark of health care delivery and that patients deserve? The answer is, “Of course not.” Everyone, including the Joint Commission, knows that health care organizations today can’t possibly meet the Joint Commission’s goals, or any other benchmarks, unless they’re embedded in huge culture changes that comprise strong leadership, good communication skills, multidisciplinary teamwork, an engaged frontline staff, and an informed governing board. That's among the reasons why progress still remains far too slow at most of the nation’s hospitals, even if pockets of excellence are becoming more numerous.

For Dr. Mark Chassin, who heads the Joint Commission, the concept that he believes can and should become a game changer is “high reliability.” That means safe and effective processes that can be executed and sustained over long periods of time. Writing in the April 2011 issue of Health Affairs, Dr. Chassin states, “What has eluded us thus far…is maintaining consistently high levels of safety and quality over time and across all health care services and settings. The pockets of excellence coexist…with enormously variable performance across the delivery system. Along with some progress, we are experiencing an epidemic of serious and preventable adverse events.”

Dr. Chassin argues that one place to start on the path to high reliability is to conduct an honest self-assessment of an organization’s readiness. WIHI host Madge Kaplan welcomes Dr. Chassin to the program to dig deeper into the subjects of excellence and reliability. He’s joined by IHI’s Maureen Bisognano, a long-time champion of high reliability. Ms. Bisognano knows that the success of any initiative to improve safety and quality reliably, and over time, depends on creating and sustaining a culture of safety, from the board to the executive to the front lines. This culture is needed across the entire continuum of care, especially at crucial intersections where patients are most at risk. Ms. Bisognano also believes that a culture of safety must be accompanied by a culture of innovation that supports and encourages professionals to test out new ideas and harvest proven methods from wherever they are found.



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