The High-Reliability Clinical Enterprise

Download the study

---

How can nurses reclaim their track record on quality improvement?

Data from the Agency for Healthcare Research and Quality confirms that after many years of improvements, the national rate of hospital-acquired conditions plateaued in 2014.

National HAC Rates, 2010 to 2014
Rate per 1,000 Discharges

1. Interim rate for 2014 calculated by the Agency for Healthcare Research and Quality on November 19, 2015.

Clinical leaders need to broaden their ambition to deliver highly reliable care if they're going to start making gains in quality improvement again. They need to ensure that every caregiver is delivering the known standard of care, every time, in every setting.

But while many clinical leaders embrace the goal of highly reliable care, unique factors in today’s complex environment make it especially difficult to achieve. Rapidly changing standards, more diverse care settings, broader organizational reach, larger care teams, and slow transition to electronic documentation all combine to make achieving high-reliability care no straightforward task.

The good news about these complicating factors is that each presents a related solvable challenge that nurse leaders can address to ensure every patient receives the known standard of care every time.

11 best practices for high-reliability care

Complicating Factor 1: Rapidly Changing Standards
New standards are adding to staff workload when they already feel overwhelmed. Read more (p.17)

• Practice 1: Frontline Standard Testing (p. 20)
• Practice 2: Data-Driven Peer Coaching (p. 25)
   Supporting tool: Midland Memorial's Pain Assessment Protocol
• Practice 3: Change Calendar (p. 30)

Complicating Factor 2: More Diverse Care Settings
It’s getting harder to create system-wide standards that work for all sites. Read more (p.35)

• Practice 4: The “Nonnegotiables” for Standards (p.39)
   Supporting tool: Sentara Healthcare's CLABSI and CAUTI Safety Bundle Poster
• Practice 5: Variance Request Support Team (p. 44)
   Supporting tool: Main Line Health's Committee Structure

Complicating Factor 3: Broader Organizational Reach
The growing distance between executives and frontline leaders makes it more difficult for executives to rely on personal influence to achieve compliance. Read more (p. 47)

• Practice 6: Executive E-visibility Bundle (p. 50)
• Practice 7: Executive Stand-In (p.53)

Complicating Factor 4: Larger Care Teams
Coordinating care across more roles, professions, and settings poses unique challenges. Read more (p. 57)

• Practice 8: Single Owner for Frequently Missed Care (p. 60)
   Supporting tool: Baptist Health Lexington's Patient Flow Nurse Job Description
   Supporting tool: St. Mary Medical Center's Medication History Script
   Supporting tool: St. Mary Medical Center's Medication History Technician Job Description and Evaluation Criteria
• Practice 9: Specialized Support Staff Roles (p. 64)

Complicating Factor 5: Glacially Slow Transition to Electronic Documentation
Time-sensitive patient information often gets buried in the EMR, preventing clinicians from providing timely, appropriate care. Read more (p. 69)

• Practice 10: Secure Clinician-to-Clinician Texting (p. 72)
• Practice 11: Secure Video Handoff (p. 76)
   Supporting tool: Prestige Care's Video Handover Checklist

Order free hard copies