High Reliability Health Care
With 6 hospitals, 3 skilled nursing facilities, a home nursing service and hospice, CHS handles nearly 240,000 emergency department visits, nearly 83,000 hospital admissions and more than 475,000 outpatient visits yearly. In service to our patients and their families, our health system is deeply committed to sustaining a culture of safety at all times. To this end, CHS is systematically advancing toward recognition as a high reliability organization (HRO).
HROs work to recognize and trap small errors before significant harm can occur. They train their leaders and staff in techniques to facilitate effective communication and situational awareness and, most importantly, to improve the culture of safety to support enhanced reporting of both harm events and near misses non-punitively so that learning can occur and processes can be changed to optimize the best outcomes. The commercial aviation and nuclear power industries exemplify highly reliable, safe operations. For instance, commercial aviation has a preventable death rate of 1.6/1 million flights, compared to the Institute of Medicine’s To Err Is Human report, which asserts that as many as 100,000 preventable deaths may occur in U.S. health care settings each year. While outcomes at CHS are far superior to those recorded nationally, we have committed the organization to achieving zero preventable harm and are making great strides forward.
As part of our commitment to achieving high reliability and zero preventable harm, CHS’s Daily Patient Safety Principles—tools that enhance high reliability learning and patient care—are in effect across the system. Each year, we present Certified Zero Harm Awards to care teams achieving flawless performance in specific measures for 12 consecutive months, and in 2016 we launched the Driving to Zero Awards. Also, through our CHS Pinnacle Award for Quality & Patient Safety, modeled after the Healthcare Association of New York State’s Pinnacle Awards, our health system annually recognizes internal projects playing a leading role in promoting improvements in health care delivery. In addition, CHS collaborates with The Joint Commission’s Center for Transforming Healthcare in providing advanced leadership training in a clinical setting.
To further mature our HRO journey, we have partnered with Press Ganey’s Healthcare Performance Improvement (HPI) strategic consulting team. Press Ganey is a leading provider of patient experience measurement, performance analytics and high reliability quality advisory solutions for health care organizations. This partnership has already yielded leadership training strategies and clinical staff training techniques with proven methods for building and sustaining a culture of safety and high reliability, which will be deployed across all of CHS in the coming months. With the core value of zero harm as a guiding principle, HPI has helped more than 800 organizations achieve and sustain an 80% or better reduction in Serious Safety Event Rates (SSER®) within 2 years.
As a foundation for this multiyear engagement with the HPI team, we conducted a retrospective common cause analysis of harmful events covering a period of three years. This diagnostic assessment yielded invaluable data to help guide our work through the process of fine-tuning our clinical processes and procedures. With our Daily Patient Safety Principles as the framework and using HPI’s Safety Event Classification system, intensive training in conformity with HRO principles is under way.
As we advance in high reliability, our focus remains, as ever, on our patients and their well-being. Our care teams continue to provide the quality services Long Islanders rely upon.
Patrick M. O’Shaughnessy, DO, MBA, FACEP, CHCQM
Executive Vice President and System Chief Medical Officer
Hospital Inpatient Quality Reporting Program – Public Reporting
American Heart Association – Get With The Guidelines Stroke