WEBVTT 00:00.000 --> 00:03.167 (inspirational music) 00:16.995 --> 00:18.792 - The Department of Defense has been on a journey 00:18.792 --> 00:21.035 ^to transform the military health system 00:21.035 --> 00:24.118 ^into a high reliability organization. 00:24.367 --> 00:27.177 ^The concept of high reliability in healthcare 00:27.177 --> 00:28.795 ^originates from our desire 00:28.795 --> 00:31.693 ^to reduce preventable harmful events to zero 00:31.693 --> 00:33.302 in an environment where human error 00:33.302 --> 00:35.782 is possible and accidents can occur 00:35.782 --> 00:38.196 due to risk factors and complexity. 00:38.196 --> 00:42.037 In HROs the entire workforce shares a single minded focus 00:42.037 --> 00:45.356 on identifying problems in high risk situations 00:45.356 --> 00:48.111 before they lead to an adverse event. 00:48.111 --> 00:51.420 High reliability can be achieved by fostering principles 00:51.420 --> 00:55.587 that enable safety, communication, and process improvement. 00:56.027 --> 01:00.194 The first of these principles is preoccupation with failure. 01:00.206 --> 01:03.677 Put simply, we must remain mindful of our actions 01:03.677 --> 01:07.677 and take precautions where risk for harm exists. 01:08.073 --> 01:11.128 The second principle is deference to expertise, 01:11.128 --> 01:14.171 a principle that is enabled by our team steps training 01:14.171 --> 01:17.122 and our see something, say something campaigns. 01:17.122 --> 01:20.799 This principle empowers those with critical information 01:20.799 --> 01:22.628 to speak up so that the patient 01:22.628 --> 01:24.381 has the best possible outcome 01:24.381 --> 01:27.527 and the team's performance is overall improved. 01:27.527 --> 01:30.203 It also reinforces that all members of the team 01:30.203 --> 01:33.170 play a vital role and are not only encouraged 01:33.170 --> 01:35.753 but are expected to contribute. 01:36.227 --> 01:38.910 The third principle of high reliability organizations 01:38.910 --> 01:41.327 is sensitivity to operations. 01:41.500 --> 01:45.176 This concept involves leaders and staff being keenly aware 01:45.176 --> 01:47.847 of the state of systems and processes 01:47.847 --> 01:49.930 that effect patient care. 01:50.178 --> 01:53.053 It involves supporting the use of regular staff huddles 01:53.053 --> 01:56.344 to share information and engage in walking rounds 01:56.344 --> 01:58.842 as the means to learn more about how leaders can help 01:58.842 --> 02:02.842 frontline staff improve care and eliminate harm. 02:03.413 --> 02:07.147 It encourages rewarding staff for reporting deviations 02:07.147 --> 02:09.064 from expected outcomes. 02:09.187 --> 02:11.677 These actions enable staff to remain attentive 02:11.677 --> 02:13.543 to frontline operations, 02:13.543 --> 02:17.036 identify and correct gaps in defenses against failures, 02:17.036 --> 02:20.524 and provide real time information on what is happening. 02:20.524 --> 02:23.456 The fourth principle of high reliability organizations 02:23.456 --> 02:25.623 is reluctance to simplify. 02:25.780 --> 02:28.535 It is a principle that reminds us that we should avoid 02:28.535 --> 02:31.763 simple explanations for errors and instead 02:31.763 --> 02:34.428 seek ways to thoroughly understand how processes 02:34.428 --> 02:38.405 and policies are interconnected and can support our goal 02:38.405 --> 02:41.322 to deliver excellent and safe care. 02:41.481 --> 02:44.322 By conducting daily safety leadership briefings 02:44.322 --> 02:47.773 to share situational awareness and identify resolutions 02:47.773 --> 02:49.379 to problems early on 02:49.379 --> 02:52.049 we demonstrate to our staff that there is a consistent 02:52.049 --> 02:54.031 pattern for following up on issues 02:54.031 --> 02:56.671 and enable the communication of resolutions 02:56.671 --> 02:59.088 to other members of the team. 02:59.325 --> 03:02.814 A commitment to resilience is the final principle of HRO. 03:02.814 --> 03:05.566 It entails an acknowledgment that in spite of processes 03:05.566 --> 03:09.121 in place safeguards and an ever present commitment 03:09.121 --> 03:12.192 to eliminating harm at every level of the enterprise 03:12.192 --> 03:15.274 systems may still fail in unexpected ways. 03:15.274 --> 03:18.461 We must continue to develop the capability to identify, 03:18.461 --> 03:21.391 contain, and bounce back from errors 03:21.391 --> 03:24.114 including engaging in worst case scenario training, 03:24.114 --> 03:28.281 practice, and leveraging in depth expertise where it exists 03:28.377 --> 03:31.585 to give us every opportunity for success. 03:31.585 --> 03:34.505 We're committed to developing our staff to maximize 03:34.505 --> 03:36.508 their full potential to provide care 03:36.508 --> 03:38.869 that is free from preventable errors. 03:38.869 --> 03:42.477 After all, high reliability organizations consist 03:42.477 --> 03:44.558 of highly reliable individuals 03:44.558 --> 03:46.820 and that is where we will make our investment 03:46.820 --> 03:48.593 and ensure that our patients receive 03:48.593 --> 03:51.510 the very best healthcare possible.