A High Reliability Organization (HRO) is one that works with complex and hazardous systems every day and yet retains a high level of safety and an error free environment. The first recognized HRO industries were the United States Navy nuclear aircraft carriers, the Federal Aviation Administration’s Air Traffic Control systems, and nuclear power plant operations. These industries operate using highly complicated and dangerous processes, yet they have the fewest safety incidents. In the past several years, hospitals and healthcare systems have also striven to become HROs.
The use of checklists in a HRO is an important part of keeping safety incidents to a minimum. Lists can help organizations avoid safety issues, avert disasters, and even aid in incident response. In aviation, a pre-flight safety checklist is a list of tasks that must be performed by pilots and crew before a take-off. Pilots also use checklists for both normal and non-normal operations, for landings, take-offs, and also for malfunctions, and emergencies. Nuclear power plant operations also involve the use of many safety checklists.
Checklists should have defined pause points so users can determine when the list should be used and when new tasks should begin. Checklist types are also important, and the style used may vary depending on the task and the experience of the user. For example, a “do-confirm” list is generally used when users are experienced with the process and have gone through the necessary steps on the list and simply run through it to ensure the process is complete. A “read-do” checklist means employees perform the tasks as they read through each list item.
Most checklists should not be lengthy as it may tempt experienced users to take shortcuts or to ‘pencil-whip’ responses. Make sure the list includes crucial and potentially overlooked steps. These may be the things that can cause the greatest harm if not checked. Use language that is simple, precise, and use terminology that is familiar to the lab staff using the list. Lastly. Test the checklist to see that it fits the criteria above, and that it accomplishes the task set for it. The real goal of using a safety checklist is to create a cultural change by enhancing teamwork, increasing safety communication and changing the understanding of responsibility for safety within the department.
Some published safety checklists exist , but your department may have its own specific needs, and these checklists may not cover them. If that is the case, create a checklist that focuses on an issue or issues you’d like changed. For example, if PPE non-compliance is on the rise, create a list that can be used daily or weekly to check specifically for that issue. Walk around and look for proper footwear, lab coat use, and face protection for example. Homemade checklists can be scored and used as a quality monitor in order to show improvement in safety over time. Make sure people are trained to use the checklists properly, and that people are consistent in how they answer individual items. It’s always a good idea to alter who uses the safety checklists as well. Make sure everyone can use them, and that will create a broader understanding of the safety needs of the department. That can go a long way toward improving the overall safety culture.
Many healthcare organizations today do not fall into the category of a High Reliability Organization. Complex and dangerous tasks do occur in the field, but safety incidents are not uncommon. It may be because employees are not educated enough about the consequences. There are definite hazards when working in laboratories and other clinic settings, but often they are not in the forefront of the employees’ minds. Safety needs to be discussed more. Or maybe the reason is that many of the hazards in the department do not always have more immediate consequences. Organisms involved with exposures have incubation periods, and disease states (like cancer) can take years to develop after a safety incident.
In the airline and nuclear industries, if a safety error is made, the consequence is usually immediate, and deadly for many. Is that it? Is that why people don’t have the same reaction to safety issues in healthcare? What can we do as safety professionals to change that? It can be changed- it will take checklists, training and raising safety awareness.