High
reliability

April 10, 2017 -- Another fascinating talk at ANIA 2017 was Amy Edmondson, "Managing the Risk of Learning: Psychological Safety in Work Teams". She, too, offered an interesting metaphor: when you get on a plane, you don't do it saying, "This will be a good flight because Jane Smith is at the controls." Yet, we do that in health care. Unlike when we fly, we don't assume that the care team is thoroughly trained and expert in delivering the best-researched and best-engineered standard of care.

Aviation has known for decades that it is a team -- not a heroic individual -- that makes it safe. In healthcare, by contrast, we often say things like, "I had the world's expert in [disease X -- my disease] treating me." The implication is that another provider would have delivered inferior care, and that there are not standards for consistently delivering best practices.

This is changing. We are starting to talk about making health care organizations be HROs: High Reliability Organizations. One standards body addressing this is the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) that is working on, among other things, the five components of safety culture.

One such component is psychological safety: no penalties for errors nor for asking for help nor for providing feedback. These are essential for an O to be an HRO. It is more emotionally satisfying to praise (or blame) people than systems. This is one of many habits we in healthcare must overcome.

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