Workforce Safety Panel: Committing to a Highly Reliable Workforce

Added on May 22, 2019

By Andrea Fitzgerald, Staff Writer

teamwork (1)Hospitals and health care systems considering an organizational commitment to Zero Harm must commit to a culture change that makes the principles of High Reliability foundational to everything they do, according to a panel of Press Ganey experts.[​1]

First applied in industries with a high potential for catastrophic errors, including nuclear power and commercial aviation, High Reliability practices in health care are good medicine and good business, as discussed in the first post of this series. By applying these practices to patient and workforce safety to better understand variability, manage change, and reduce errors, organizations are able to move beyond compliance and toward Zero Harm.

In this final post, the panel provides insights and reflections from their own experiences in health care and other industries to encourage and support hospitals and health care systems as they work toward becoming High Reliability Organizations (HROs).

Q: Reflecting on your own experiences with organizations on their journey to becoming an HRO, what advice would you give to those in health care who are considering the commitment to a highly reliable workforce?

Craig Clapper: The hospitals and health care systems that make a commitment to a highly reliable workforce will advance their transformation journeys. Such a commitment will not only move the needle in safety, it will drive performance improvement across all domains. Year to year, some health care organizations will pick out a new priority episodically rather than see the full integration as the greater performance picture. Let’s say one year an organization focuses on reducing patient harm and workforce injuries. Thinking it’s now covered, the following year the organization may switch focus to improving patient experience. If the organization sees improvement in that domain, in the third year it may shift again to make workforce engagement the next big priority. This type of siloed thinking stunts improvement and confuses the workforce. Instead, we must shift this approach to focus on improving safety, quality, experience, and engagement in an integrated way to improve more rapidly year after year.

Julie Samuelson: Achieving High Reliability is a significant commitment that can’t be taken lightly. It requires that senior leaders believe achieving Zero Harm is not only mission-critical, but also a business imperative for achieving and sustaining high performance across care domains, as Craig said. It also requires an effective and ongoing communication plan in which all levels of leadership clearly define High Reliability and its importance to patients, families, individual members of the workforce, and the overall organization. Messaging should be customized to each audience and highlight stories of real patients and families. These leaders must also be given professional development opportunities to hone their change management and execution skills to ensure they can identify and remove barriers to consistent and reliable care delivery. It’s an enormous undertaking that requires allocating the necessary organizational resources in terms of talent and time, but the result—ensuring that everyone in health care receives a safe, high-quality, patient-centered experience—is invaluable for both patients and caregivers.

Rob Douglass: That is why leadership must understand and accept the responsibility of owning safety and leading their health care organizations to Zero Harm. Safe outcomes for both patients and employees stem directly from their championing the belief that harm is not “the cost of doing business” and that Zero Harm is the only acceptable pillar. Looking to other complex, high-risk industries shows us that achieving Zero Harm is possible. Health care is not “uniquely unique,” as some people have suggested. The lessons learned from other industries and complex High Reliability Organizations apply equally to health care, and to suggest otherwise is an abdication of an organization’s critical duty to protect their workforce and patients. They must be the ones to deliver the Zero Harm outcome.

Donna Cheek: Rob is right. Workforce injuries are more than a number, and they must be recognized and reported as more than a “cost” to the organization. It is up to senior leadership to learn how and why injuries occur, to remove any barriers to safe behaviors and processes, and to support a culture of safety. Doing so requires establishing behavior-based expectations, building a burning platform for following safety policies and utilizing equipment as appropriate, and allocating sufficient resources to ensure that tools are available for injury prevention. In short, leaders have to make it easy for the workforce to do the right thing.

Don Goble: Doing so will require leaders to overcome what I believe is the biggest hurdle in any organization’s journey to becoming an HRO: recognizing what constitutes hazards and unsafe behaviors and then not only communicating that to the entire workforce but determining how to mitigate or eliminate those hazards to prevent injuries moving forward. For example, at a nuclear power plant where I previously worked, we held a pre-job brief for a refueling outage and someone asked what was the worst thing that could happen. One answer was that someone could get injured, but the only mitigation action discussed was to be careful. Being careful isn’t a mitigation strategy, and unfortunately in this case, an employee did sustain a serious neck injury. Properly identifying and eliminating risks and hazards requires a lot of work around culture—much of which Donna outlined—as well as robust safety procedures and policies. There are no shortcuts.

This is the final installment in a seven-part series on making the health care workplace a safe and highly reliable environment for patients and caregivers. Part I identified deficiencies in data, education, and investments in workforce safety as top obstacles for health care organizations to overcome on their journey to Zero Harm. Part II provided insights into the possible detractions from reporting or speaking up about unsafe practices resulting in errors and harm. Part III honed in on information that executives need in order to advance workplace safety and the pursuit of a fair and just culture. Part IV took a closer look at the CEO’s role in an organization’s High Reliability journey. Part V discussed ways in which measurement and reporting can inform and inspire every member of the workforce to reduce harm. Part VI explored opportunities for leaders to support and empower occupational nursing staff to sustain the organization’s safety culture. 


[​1] Panelists from Press Ganey’s Transformational Advisory Services include Donna Cheek, a safety expert with more than four decades of health care experience in multiple executive and nurse executive roles; Rob Douglass, a safety expert and former commanding officer with 30 years of experience in the nuclear naval and commercial energy industries; Don Goble, a safety expert with more than 35 years of experience in naval and commercial nuclear power; and Julie Samuelson, RN, a patient experience expert with more than 40 years of experience in health care across a range of settings. Christy Dempsey, chief nursing officer and president of Clinical Excellence Solutions, moderated the discussion, and Craig Clapper, Transformational Advisory Services partner, contributed.