David I.

Background: Artificial intelligence (AI) has great potential to improve health care quality, safety, efficiency, and access. However, the widespread adoption of health care AI needs to catch up to other sectors. Challenges, including data limitations, misaligned incentives, and organizational obstacles, have hindered implementation. Strategic demonstrations, partnerships, aligned incentives, and continued investment are needed to enable responsible adoption of AI. High reliability health care… Show more

Background: Artificial intelligence (AI) has great potential to improve health care quality, safety, efficiency, and access. However, the widespread adoption of health care AI needs to catch up to other sectors. Challenges, including data limitations, misaligned incentives, and organizational obstacles, have hindered implementation. Strategic demonstrations, partnerships, aligned incentives, and continued investment are needed to enable responsible adoption of AI. High reliability health care organizations offer insights into safely implementing major initiatives through frameworks like the Patient Safety Adoption Framework, which provides practical guidance on leadership, culture, process, measurement, and person-centeredness to successfully adopt safety practices. High reliability health care organizations ensure consistently safe and high quality care through a culture focused on reliability, accountability, and learning from errors and near misses.

Observations: The Veterans Health Administration applied a high reliability health care model to instill safety principles and improve outcomes. As the use of AI becomes more widespread, ensuring its ethical development is crucial to avoiding new risks and harm. The US Department of Veterans Affairs National AI Institute proposed a Trustworthy AI Framework tailored for federal health care with 6 principles: purposeful, effective and safe, secure and private, fair and equitable, transparent and explainable, and accountable and monitored. This aims to manage risks and build trust.

Conclusions: Combining these AI principles with high reliability safety principles can enable successful, trustworthy AI that improves health care quality, safety, efficiency, and access. Overcoming AI adoption barriers will require strategic efforts, partnerships, and investment to implement AI responsibly, safely, and equitably based on the health care context. Show less

This study demonstrates how becoming a high-reliability institution in health care is a priority, given
the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions… Show more

This study demonstrates how becoming a high-reliability institution in health care is a priority, given
the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities. Show less

Organisations, specifically in the healthcare industry, often find themselves in a state of ‘Reliability Divide’. This is a concept that the authors have developed to explain why most organisations never realise the culture change needed to become highly reliable. In an organisation there is a variable time frame to get to daily work. Because of the time involved, some of the front-line staff who participated in theory, academics and now operations have become mid- or lower senior level… Show more

Organisations, specifically in the healthcare industry, often find themselves in a state of ‘Reliability Divide’. This is a concept that the authors have developed to explain why most organisations never realise the culture change needed to become highly reliable. In an organisation there is a variable time frame to get to daily work. Because of the time involved, some of the front-line staff who participated in theory, academics and now operations have become mid- or lower senior level leaders. Along the journey they become the vector that infiltrates the organisation to reach Fabric. Multidirectional high reliability organisation (HRO) adoption starts to occur here, which further drives an organisation towards zero harm (nirvana). Show less

Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean… Show more

Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean. Truman VAMC was compared with other Veterans Health Affairs (VHA) facilities regarding burnout and employee satisfaction metrics. Truman VAMC saw significant changes in multiple HRO metrics (P < 0.001) as well as improvements in work group psychological safety and employee exhaustion (P < 0.001). High burnout rates decreased by 52% (6.2%–2.95%; P < 0.001). Truman VAMC went from 75th to the No. 1 ranked VHA facility regarding Best Places to Work. These findings have significant national policy implications given the effects of burnout. Show less

A framework for implementing high-reliability organizations (HROs) in the nuclear power and aviation industries is well established and grounded in 5 core principles: preoccupation with failure, sensitivity to operations, reluctance to simplify, commitment to resilience, and deference to expertise. Translating HRO principles to health care has become a major focus to manage risk and reduce harm. Several strategies have been published without consensus as to either a specific framework for HRO… Show more

A framework for implementing high-reliability organizations (HROs) in the nuclear power and aviation industries is well established and grounded in 5 core principles: preoccupation with failure, sensitivity to operations, reluctance to simplify, commitment to resilience, and deference to expertise. Translating HRO principles to health care has become a major focus to manage risk and reduce harm. Several strategies have been published without consensus as to either a specific framework for HRO implementation or the outcome metrics for measuring success. The Veterans Health Administration (VHA) National Center for Patient Safety (NCPS) developed a high-reliability hospital (HRH) model for HRO implementation and piloted this model in a single Department of Veterans Affairs (VA) Medical Center during a 3-year period. This article describes detailed steps for HRH model implementation and analyzes its impact on patient safety culture and clinical outcomes. The HRH model focuses on multiple HRO principles over a protracted period with an expectation that patient safety infrastructure, practices, and culture will improve and over time result in improved clinical outcomes. #highreliability #patientsafety #trumanva #kcva #va #davidbisaacks #patientexperience #reliability #hro Show less