Caveats for high reliability in healthcare

Improving long-term care services: insights from high-reliability organizations

PURPOSE

Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs).

DESIGN/METHODOLOGY/APPROACH

The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches.

FINDINGS

To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience.

ORIGINALITY/VALUE

This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.

Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis

BACKGROUND

Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication.

PURPOSE

The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change.

METHODOLOGY/APPROACH

The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC.

RESULTS

During the study period (2015-2018), 344 participants completed the survey for an overall response rate of 53.5% (n = 643). Postintervention, the RC index significantly increased from 3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements.

CONCLUSION

Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to team members who rotate within the hospital (i.e., pharmacists who rotate to other units every month).

PRACTICE IMPLICATIONS

This intervention holds promise for teams seeking best practice models of "high-reliability" care organization and delivery. Sustained changes from this intervention represent an important area of future practice-based research.