Research

The High-Reliability Clinical Enterprise

High Reliability

While nurse leaders’ efforts to improve care quality and safety in recent decades have led to significant gains in quality, these improvements are beginning to stall. To resume making gains, clinical leaders need to broaden their ambition to deliver highly reliable care.

This study equips nurse leaders with actionable guidance on achieving high reliability across their health systems despite the many complications posed by today’s environment.


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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

National HAC Rates

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)

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)

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)

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

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)

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