Manifestations of High-Reliability Principles on Hospital Units With Varying Safety Profiles: A Qualitative Analysis.
Sarah E Mossburg, Sallie J Weaver, MarieSarah Pillari and 1 others
PMID 30480611WHAT IT FOUND
High-performing safety units fostered direct speaking up and system-focused error analysis.
Low-performing units relied on anonymous reporting, blamed individuals for errors, and lacked concrete proactive safety strategies. Nurses in safer units felt empowered to trust their gut and speak directly.
Key findings
01Nurses in high-performing units defined safety to include being heard when speaking up, whereas low-performing units relied on anonymous reporting methods.
02High-performing units used event reporting to highlight system errors, while low-performing units focused on educating or blaming the individual nurse who made the error.
03High-performing units articulated concrete methods for proactively identifying safety issues, such as simulation, while low-performing units did not.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only included four units from two hospitals, so the findings may not apply to other settings. The units compared had different patient populations and staffing structures, which could have influenced the results. The questions were not designed to explore all aspects of mindful organizing, such as resilience or deference to expertise.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret these findings as proof that adopting specific communication styles causes higher safety scores. This is a qualitative description of existing cultures in selected units, not an experimental test of an intervention.