Creating Highly Reliable Hospitals

“If I bring my daughter to your hospital, I expect three things: don’t hurt her, heal her and be nice to her. If you hurt her, I don’t care that you eventually healed her and that you were nice to her,” Kerry Johnson told members of the South Carolina health care community at the 4th Annual South Carolina Patient Safety Symposium. “I’m not satisfied with our experience.” Exceptional care must include safety, along with quality and satisfaction. Unfortunately, in the past, hospitals have put more emphasis on healing and being nice than on preventing harm, he said. Safety isn’t just a priority. It has to be a core value on which other decisions are based.

As Kerry Johnson stepped to the podium in Columbia, emergency efforts were underway at the Fukushima Daiichi nuclear power plant in Japan to cool three malfunctioning nuclear reactors and prevent a catastrophic meltdown. The challenge, of course, was created by the earthquake, recorded as 9.0 on the Richter scale, and related tsunami that had devastated parts of Japan just days before.
An engineer who spent his early career helping make nuclear plants and nuclear submarines safer, Johnson acknowledged the headlines while explaining that despite the current situation, nuclear energy has become a highly reliable industry. That means it has systems that prevent the vast majority of possible catastrophes despite a risky and complex environment where accidents can be expected to occur. Other highly reliable industries include aviation and strategic defense systems.

Health care, however, has lagged behind. In fact, Johnson pointed out, serious safety events occur in hospitals 55 times more often than in nuclear power plants. “Health care is high risk, more dangerous than mountain climbing or working on an oil rig in the Gulf of Mexico,” he explained.

The key to becoming a highly reliable organization or industry is an intrinsic commitment throughout the organization to meet performance expectations. It’s about choosing the right people and shaping a culture that creates safety. Reliable organizations have reliable standards, expect a certain behavior from employees and design their systems so it’s easy to do the right thing and hard to do the wrong thing.

Johnson described safety as a dynamic non-event where everyone has a role in creating and maintaining it. Workers consistently follow the procedures developed, are responsible not only for themselves but for the people around them and feel compelled to speak up when they see something that doesn’t look quite right. Highly reliable organizations are characterized by an obsession with failure. The people employed by the organization are constantly thinking about what can go wrong and how to prevent it. They operate with remarkable consistency and effectiveness and investigate not only when an error occurs but also when any behavior that could have led to an error occurs. Investigations are for the purpose of learning, not punishing.

The good news is that safety is a science, and very high levels of safety can be achieved by employing high reliability principles. Using nuclear powered submarines as an example, Johnson said after 5,500 cumulative years of nuclear reactor operations and 127 million miles submerged (which equals 265 round trips to the moon), they have had zero reactor accidents. Plus they are operated by 20 year olds.

Johnson has now turned his attention to bringing the science of safety to hospitals. Applying these principals to 280 hospitals, including some in South Carolina, he has seen an 80 to 90 percent reduction in errors.

Is it possible to get to zero serious harm events? There is always the possibility of human error, but we can always work toward that goal. “The journey to zero is the only acceptable goal,” Johnson said.

05-18-2011 10:34 (EDT)