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Becoming a High Reliability Organization

Operational Advice for Hospital Leaders

This document is written for hospital leaders interested in providing patients safer and higher quality care. It presents the thoughts, successes, and failures of hospital leaders who have used concepts of high reliability to make patient care better. High reliability concepts are tools that a growing number of hospitals use to help achieve their safety, quality, and efficiency goals. Creating a culture and processes that radically reduce system failures and effectively respond when failures do occur is the goal of high reliability thinking.

Prepared for the Agency for Healthcare Research and Quality (AHRQ) by The Lewin Group and The Delmarva Foundation.



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Executive Summary
Transforming Hospitals Into High Reliability Organizations
  Introduction and Overview
Understanding High Reliability Organizations and Why They Matter
  Challenges Calling for High Reliability
  High Reliability Organizing Concepts
  Use of High Reliability Concepts in Hospitals
Applying High Reliability Concepts to Hospitals
  Changing and Responding to the Hospital's Environments
  Planning and Implementing Improvement Initiatives
Doing the Work
Measuring Progress
  Measurement Insights
  Specific Measurement Areas
Implementing Specific Improvement Initiatives
Spreading Improvements to Other Units and Facilities
Using This Information
Appendix A: Sentara Network Site Visit
Appendix B: Exempla Healthcare Site Visit
Appendix C: Cincinnati Children's Site Visit
Appendix D: Fairview Health Services and Alina Hospitals & Clinics Site Visit
Appendix E: Case Studies: Sentara Leigh
Appendix F: Case Studies: Christiana Care
Appendix G: About the HRO Network


Copyright Information and Disclaimer

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of the copyright holders.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services.

Page last reviewed April 2008
Internet Citation: Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. April 2008. Agency for Healthcare Research and Quality, Rockville, MD.