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UCA18: Developing a Healthcare High Reliability Program

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At this year's annual Urgent Care Association (UCA) conference (Oct. 12-14), themed "New Frontiers," Michael Shabot, MD, the chief medical officer at Memorial Hermann Health System, outlined steps for implementing an innovative healthcare high reliability program.

High reliability organizations (HROs) are those that operate for extended periods of time in complex conditions without serious accidents or failures. Traditionally, high reliability was not a characteristic associated with healthcare. In fact, when they were first described, HROs were researched almost exclusively in high-risk contexts (classic examples from the original research include nuclear power operations, commercial aviation, and naval aircraft carriers).

However, as Urgent Care in the United States diversifies and evolves, providers would benefit from adopting a high-reliability mindset. According to the AHRQ Patient Safety Network, high reliability models emphasize five ways of thinking, outlined below with tips for successful practice:

Ways of Thinking In Successful Practice
  • 1) Preoccupation with Failure
Successful HROs focus on what could go wrong. Urgent care providers should be preoccupied with predicting future failures, and exercising constant vigilance. It is unrealistic to assume new accidents will resemble those that have occurred in the past.
  • 2) Reluctance to Simplify
Urgent care is a complex and dynamic field, even for those who have been in practice for years. It is unrealistic to assume workflow standardization is a panacea.
  • 3) Sensitivity to Operations
Urgent care providers should try to see "the big picture" and resist departmental, organizational, or position-specific siloing.
  • 4) Deference to Expertise
Expertise is not necessarily hierarchical. Successful urgent care leaders foster an open forum for conversation and solicit input from providers at all levels of seniority. New providers can offer fresh perspectives or new approaches; senior providers can offer institutional knowledge or comment on historical approaches.
  • 5) Commitment to Resilience
High reliability is not a static state of achievement—it's an ongoing process. Urgent care providers should continuously strive to strengthen functional systems and improve flawed systems.

According to UCA CEO Laurel Stoimenoff, "a pessimist is just an optimist with experience." Urgent Care providers can achieve high reliability by regularly engaging in cross-collaboration, soliciting expertise with an egalitarian mindset, and approaching problems with "experienced optimism."

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