At the Sacramento Medical Center, Christine Nguyen, RN was preparing a patient for discharge when she noticed part of their face drooping. Trusting her instincts and training, Christine initiated a Rapid Response Team call to act on her suspension that the patient was having a stroke.
Her prompt action led to the patient immediately receiving a CT scan, which confirmed the stroke and resulted in medication being administered without delay. The patient was later discharged without any paralysis or effects from the stroke.
“Christine’s keen attention to detail, expertise and swift response ensured the patient could return home at their baseline, still able to enjoy life with their family,” said Esperanza Chavez, MSA, BSN, RN, NEA-BC, Chief Nurse Executive at the Sacramento Medical Center. “Christine’s response to the patient exemplifies the High Reliability Organization (HRO) principle of preoccupation with failure.”
This principle involves a continuous concern with the possibility of failure and the commitment to identify and address any potential issues promptly. “In HROs, even small deviations from the norm are taken seriously, and staff members are trained to recognize and respond to early signs of potential problems,” added Chavez.
In addition to preoccupation with failure, the principles of HRO are sensitivity to operations; reluctance to simplify; resilience; and deference to expertise.
Ace Delosantos, BSN, RN, pictured above with Chavez, staff nurse IV, 5th floor telemetry unit, Unit Practice Council chair teaches HRO and Daily Management System (DMS) workshops. “HRO and DMS connect our day-to-day work with Kaiser Permanente’s goals and takes our nursing practice to the next level,” he said.
Nurses play a vital role in achieving a high reliability culture by actively identifying and reporting potential safety hazards, promoting open communication, and advocating for patient safety at every level of care.
For example, a nurse in the main operating room at the Roseville Medical Center noticed something incorrect about a patient’s consent form posing a potential risk to patient safety. The nurse spoke up and they stopped the line until the issue was addressed.
Debbie Reitter, DNP, RN, CNS, NEA-BC, pictured at left, Chief Nurse Executive at the Roseville Medical Center says, “When nurses show up with a HRO mindset, they are better advocates for their patients and their safety.”
Principles of HRO and the role of nurses
- Sensitivity to operations: Being acutely aware of the environment and actively monitoring for potential issues.
- Preoccupation with failure: Viewing near misses as learning opportunities and actively seeking ways to prevent them.
- Reluctance to simplify: Not dismissing concerns as minor and thoroughly investigating potential causes of issues.
- Resilience: Actively identify and report safety concerns, adapt to changing situations, communicate effectively with your team, and learn from errors to ensure system reliability and protect patients from potential harm.
- Deference to expertise: Respecting the knowledge and insights of all team members, regardless of hierarchy, and valuing input from those closest to the patient.