Safety and High Reliability in the Hospital Radiology Department

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 - Caution Radiation

What is a high-reliability organization (HRO)? Quint Studer, founder and board chair at Studer Group, Inc., defines high-reliability organizations as “organizations with systems in place that make them exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors.”1 The original HRO research focused on complex environments with a high probability of accidents (naval aircraft carriers, the air traffic control system, and nuclear power generation), so the guiding principles translate well to the radiology department, where the primary objective is to perform high-quality examinations and provide accurate interpretations in a timely fashion while keeping patients safe.

High reliability performance–or trustworthiness–is based on principles that define a strong safety culture. Derived from the Institute of Nuclear Power Operations (INPO), a culture of safety within healthcare is “an organization’s values and behaviors–modeled by its leaders and internalized by its members–that serve to make [patient] safety the overriding priority.”2

To create and sustain a meaningful culture of safety, everyone assumes responsibility for patient safety. Leaders make commitment to safety a top priority: An atmosphere of trust facilitating honest communication without fear of punitive action is critical. In turn, this cultivates a questioning attitude and healthy opportunities for staff development.

Decision-making is always focused on safety first, and associates value health care and view their role in serving patients a privilege. A strong emphasis on learning and process improvement pervades the organization, and policies and procedures are regularly reviewed and modified to reflect patient safety, a dynamic phenomenon under constant scrutiny to affect ongoing positive growth.2

Leading an HRO

Leaders within an HRO must approach the challenge with clarity and purpose and embrace the cultural transformation required to meet strategic imperatives. They model behavior that reflects commitment to safety for patients and associates; train the team; and rely on metrics such as the serious safety-event rate (SSER) to monitor harmful events.

The day begins with a safety huddle or safety check-in, a mechanism that encourages error, problem, and event reporting (the so-called holes in the Swiss cheese). This is a time to identify barriers that impede team members from performing effectively to prevent patient or associate harm. Leaders publicly acknowledge those who speak up in the interest of safety and applaud those who question classic dogma, engage in thought sharing and “think outside the box” to improve quality and patient safety.

Study Date Study Description A Loaded (ml) A Delivered (ml) RIS Volume RIS Volume Variance PACS Volume PACS Volume Variance Saline in PACS
0/00/0000 00:00 CT Chest Pulm Embolism 71.49 70.14 200 129.86 51 19.14  
0/00/0000 00:00 CT Chest, Abdomen AND 150.55 149.75 97 52.75 97 52.75  

Leaders hold themselves and the team accountable, creating an atmosphere of collegiality, teamwork, and collaboration in which everyone adopts the practices necessary to reduce human error. Leaders reinforce good habits, correct poor ones, and never punish honest mistakes. On the other hand, they demonstrate zero tolerance for reckless behavior. Ambassadors for a fair and just culture, they support “Red Rules”, hospital-wide mandates observed to ensure patient safety. All practitioners are expected to be in compliance and violation can result in serious disciplinary consequences. An example of a Red Rule is the “time out” before the commencement of any invasive procedure.

Truly modifying behaviors, attitudes, and performance among a heterogeneous group of individuals requires transformational change and the commitment to incremental stages of progress. The process can be slow, but ultimately quite rewarding. The leader plays a pivotal role in maintaining momentum and creating synergism among the team, so the importance he or she attaches to the initiative is critical.

Rather than view the process as a directive from hospital administration, an effective leader welcomes the challenge, champions the purpose and supports the efforts of others in order to sustain growth and development. A good leader seeks out the value each person on the team brings to the table and nurtures it. Individuals become genuinely engaged when they feel that what they do is worthwhile and substantive. People follow leaders who are authentic,