Using Change and Innovation to Create a

High Reliability Nursing Program

Denise Bosworth, MSN, RN, CNE

Geri Chesebrough, DNP, RN, CNE

Learning Objectives

2

1. Identify and describe five traits of a high reliability nursing

program.

2. Propose at least one action step to take for each of the five

traits.

3. Summarize three challenges to implementing a change and

how to overcome them.

Overview of

High Reliability Organizations

5 Traits of High Reliability Organizations

1. Preoccupation with failure

2. Reluctance to simplify

3. Sensitivity to operations

4. Commitment to resilience

5. Deference to expertise

Oster & Brataan (2016)

Eck, et al. (2011)

High Reliability Organizations

Process Improvement

CultureLeadership

5 Traits of High Reliability Organizations

•

•

Preoccupation with Failure

•

•

Reluctance to Simplify

•

•

Sensitivity to Operations

•

•

Commitment to Resilience

•

•

Deference to Expertise

Leadership

Occurs at all levels in the organization

Leadership can be formal and informal

Must support an environment of learning

Moving to a team approach for process improvement

Process Improvement Models

PDCA

CQI

Six Sigma

Lean

Change Theories

Lewin Kotter

Coping with Change Activity

Culture Change - How to make it stick

Fostering a Creative Culture

Collaborative Approach

Create a “no fear” climate

Stretch beyond your comfort zone

Celebrate Individuality and Encourage Uncertainty

Putting it all together

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• Develop a culture that works to achieve consistent excellence.

• Learn from all experiences and evaluations.

• Proactively plan for success through process improvement.

• Plan for success as a team that is supportive of change.

References Barry, R., Smith, A.C., & Brubaker, C.E. (2017). High-Reliability Healthcare Improving Patient Safety and Outcomes with Six

Sigma (2nd ed.). Chicago, IL: Health Administration Press.

Chassin, M.R.& Loeb, J.M. (2013). High-Reliability health care: Getting there from here. The Milbank Quarterly. Retrieved

from: https://www.jointcommission.org/assets/1/6/Chassin_and_Loeb_0913_final.pdf

Coping With Change, 2009. Retrieved from: http://www.factivities.com/change_management/CopingwithChange.html

Dawson, P., & Andriopoulos, C. (2014). Managing Change, Creativity, and Innovation, (2nd ed). London: Sage.

Eck, J. (2016). Failure is not an option: Making the case for high reliability educaiton systems. SEEN Connect. Retrieved from:

https://www.seenmagazine.us/Articles/Article-Detail/ArticleId/5993/Failure-Is-Not-an-Option-Making-the-Case-for-High-

Reliability-Education-Systems

Eck, J.H., Bellamy, G.T., Schaffer, E., Stringfield, S., & Reynolds, D. (2011). High Reliability Organizations in Education.

Noteworthy Perspectives. Retrieved from: https://eric.ed.gov/?id=ED544261

Gill, R. (2013). Theory and Practice of Leadership, (2nd ed). London: Sage.

Oster, C.A. & Braatan, J.S. (2016). High Reliability Organizations: A Healthcare Handbook for Safety and Quality. Indianapolis,

IN: Sigma Theta Tau International.

Porter-O’Grady & Malloch (2015). Quantum Leadership: Building Better Partnerships for Sustainable Health, (4th ed).

Burlington, MA: Jones & Bartlett

Weick, K.E. & Sutcliffe, K.M. (2015). Managing the Unexpected (3rd ed.). Hoboken, NJ: John Wiley & Sons.