ASSESSMENT OF LATENT ORGANIZATIONAL RISK: AN APPLICATION OF HIGH RELIABILITY PRINCIPLES AND ORGANIZATIONAL ACCIDENT THEORY
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Abstract Problem-Theory For over fifteen years, the health care industry has fallen short in its search for effective strategies to reduce incidents of medical error and eliminate preventable harm. Patients continue to be harmed at alarming rates by the very health care delivery system intended to heal them. Early human error and systems theory combined with more contemporary theory about organizing highly reliable systems has inspired the development of a novel framework to define Latent Organizational Risk. Methods Based on this framework, a practical method was developed to identify latent adaptive organizational risk using secondary data commonly collected by hospitals in the United States. Clinical units with signals of adaptive risk were identified by triangulation of unit-level safety culture, employee engagement and patient experience data at five hospitals within a large academic medical center. After a feedback intervention, units with high adaptive risk were compared with units without adaptive risk in terms of their safety and teamwork climate. The conceptual framework also informed development of a practice tool to guide leaders in assessing the latent patient safety risks associated with their strategic and financial decisions. Likewise, the tool encouraged leaders to design appropriate mitigation strategies to reduce the technical and adaptive risks that may be created by or hinder successful improvement efforts. Results Data from 356 units in five hospitals across the Johns Hopkins Health System were subjected to the triangulation methodology. Sixteen units were determined to be at high latent adaptive risk. Significant improvements in safety and teamwork climate were realized in those units following a feedback intervention. In a separate initiative, the Latent Risk Assessment tool was used by health care leaders to proactively identify downstream risks of high level leadership decisions, and to develop habits for high reliability organizing. Conclusions For health care to achieve a level of safety commensurate with high reliability industries, fundamental changes are needed in how care processes are planned and organized. One key challenge ahead for health care leaders will be the adoption of new leadership habits to achieve more reliable and safe health care. An essential role for health leaders will be the analysis of existing data sources to identify, understand and mitigate risk of patient harm. Using the methods and tools outlined in this thesis, leaders will be able to expand their capacity to create the safe delivery systems our patients need and deserve.