2020 was designated by the World Health Organization as the Year of the Nurse and Midwife. Instead, it has been the year of COVID-19. Healthcare organizations across the continuum of care have been besieged with critically ill people, with shortages of supplies and equipment to deliver care, and with frontline clinicians often forced to provide care with insufficient personal protection equipment. The pandemic—which already has claimed more than 215,000 lives (Johns Hopkins University of Medicine Coronavirus Resource Center, 2020) and more than 1,700 healthcare providers (Frellick, 2020) in the US—must lead to systemic change in the healthcare industry. If ever we have been in need of highly reliable healthcare organizations, this is the time.
Leadership commitment, a culture of safety, and continuous quality improvement processes are three necessary elements of high reliability organizations (HROs). Leadership comprises the governing body, medical staff, management, and nursing leaders. A safety culture is one that has a relentless focus on delivering safe care, where frontline nurses and others feel comfortable reporting near misses and actual errors. A continuous focus on quality improvement means all people in an organization are knowledgeable about quality indicators for their particular areas and their progress in meeting target outcomes.
The recently released report Frontline Nurses (WikiWisdom, 2020) poignantly describes the experiences of nurses working on the front lines of the COVID-19 pandemic. They propose solutions to improving healthcare settings, which completely align with HROs. These include:
Developing a comprehensive plan for crisis care that includes input from frontline nurses
Providing nurses emotional support on the job
Increasing administrative transparency for patient safety
Giving frontline nurses a place at the table and committing to integrating their recommendations
While the focus of nurses and other healthcare providers is primarily on the provision of care, what these solutions point to is the importance of equal attention to our systems of care delivery and safe working environments for people who work in highly complex systems.
This volume, the second edition of High Reliability Organizations: A Healthcare Handbook for Patient Safety & Quality, builds on its predecessor by retaining the concepts of high reliability and HROs from the first edition but with updated evidence. What is new is the application of the principles and practices of HROs to many contemporary challenges in healthcare. The various chapters attend to the multiple facets of HROs and apply the standards to everyday components of care. Multiple contemporary practice applications exist, such as Chapter 27 on the COVID-19 pandemic and HROs, or the use of HRO principles in the operating room suite in Chapter 28. The book also introduces readers to the importance of applying HRO principles and practices to ambulatory care and to the increasing use of telehealth.
Editors Cynthia Oster and Jane Braaten continue to provide clear information on how to develop HROs so they facilitate safe passage for patients and families and guidance in moving toward zero harm. They stress the importance of active nursing engagement in building HROs focused on safety and quality across the continuum of care, and they provide a virtual resource toolkit to prepare nurses to be at the table building safe systems of care. Never has the need been more acute in healthcare.
–Jane Barnsteiner, PhD, RN, FAAN