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Make Your Facility a High Reliability Organization
Implement standardized, evidence-based practices to boost efficiency and patient safety.
Spence Byrum
Publish Date: May 25, 2016
OR Excellence
Spence Byrum Spence Byrum

Speaker Profile

  • CEO and co-founder of HRS (High Reliability Solutions) Consulting, Inc.
  • Former pilot and safety officer for the U.S. Coast Guard.
  • Has helped more than 600 facilities implement High Reliability solutions.

About 40 years ago, the airline industry realized it had a problem. Each pilot and flight crew had their own way of doing things, and the variability was leading to deadly mistakes and crashes. The industry eventually invested in High Reliability solutions, and transformed flying into the safe standardized and predictable experience it is today. Now it's time to do the same for surgery. Spence Byrum will share the concepts of High Reliability and how they can work in your facility to improve patient care and outcomes.

  • The start of High Reliability solutions. I started out as a Coast Guard pilot. Back in those days, we didn't have a lot of High Reliability tools. Pilots did things in a fairly organized manner, but we didn't always fully utilize checklists, Crew Resource Management and things like that. As a result, planes crashed much more frequently than they do today. The industry decided there had to be another way to do things. So, we embraced this idea of High Reliability, and flying became much safer. Other industries, including health care, started to look at how aviation standardized these best practices, and they wanted to see how it could apply to them.
  • The ideal surgical facility. The ideal facility would be one that standardizes processes and procedures wherever possible. It does not rush through site verification, marking, the time out or the count. It values the input of all team members and ensures that someone is able to speak up if there is something that causes them concern. Most importantly, it is an organization that says that its goal is to have absolutely no avoidable errors, zero, in its facility.
  • Embrace checklists. In health care, some think checklists are a bad word. We've heard people say that checklists take away the individual's ability to think. But in High Reliability Organizations, it's the opposite. The checklist keeps you from forgetting the most important things, so it frees your mind to analyze and reason, therefore making you a better deliverer of care. But you can't just hand out a checklist and think that it's going to implement itself and instantly make patients safer. It won't. The pre-procedure time out (PPTO) is a great example of this. The Joint Commission has mandated the PPTO for more than a decade, but unfortunately, they didn't give specifics to how it should be carried out, and that's one reason why we haven't yet eliminated avoidable adverse events.
  • Another problem is that surgeons or staffers are often disengaged with the checklist. I compare it to flying a plane. If you got on a plane with a pilot who said that he didn't feel like doing the pre-takeoff briefing, or just rushed through his pre-flight checks, would you want to be on that plane? Clinicians need to look at each patient in that light, since the patients trust them with their lives each and every time they enter that OR.

  • Staff and surgeon resistance. There's a saying: The only person who likes change is a baby with a dirty diaper. And frankly, we see this inside and outside of health care. People tend to like to do things their own way. One way to inspire change is to make sure that if you are implementing a new checklist or patient safety initiative, you give the specifics and expectations to your team. You can't just say "do the time out" — you need to tell them how to do it, when to do it, why they're doing it, who needs to participate, and how they'll know that they accomplished their goal. OSM