High Reliability Organizations
A high-reliability organization is one that operates high-hazard, complex domains for long periods without incurring any catastrophic failures or serious accidents (Christianson et al., 2011). The principles of high reliability encompass effective standardization and also include persistent mindfulness. HROs cultivate resilience by prioritizing safety in a relentless manner over other performance pressures. HROs utilize systems thinking in evaluating and designing for safety while keenly being aware of the fact that safety is a property that is not static but rather emergent. Hence, this kind of organization works to create an environment where there are anticipations of potential problems, early detection of the same and early response to prevent consequences that are catastrophic (Christianson et al., 2011).
Several industries have transitioned into becoming successful HROs, and this includes electrical power grids, aircraft carriers, and wildland firefighting. In healthcare, the concept of HRO differs from other industries because of the complexity that can arise from the manifestation of illnesses (Chassin & Loeb, 2013). The Premium non nocere is the central medicine concept of not doing harm to patients, and yet everyday patients get harmed. Accurate diagnosis and effective therapy delivery can be complicated by conditions that change very fast, incomplete knowledge, and high uncertainty situations, which are ubiquitous situations among the ill (Riley et al., 2010). However, this difference should not be so as clinicians can learn from scholars who carry out studies in industries that have tolerance for errors that are extremely low yet manage to maintain performance that systemic issues and exceptionally high in conditions that are quickly dynamic. Hence, the healthcare industry can utilize various models, including normal accident theory, resilience engineering, high-reliability organizing, and organizational accident studies (Riley et al., 2010).
Medical errors exist even after nurses do the 5 rights for a number of reasons, including distraction, environment, lack of understanding and knowledge, patient information that is incomplete, memory lapses, and systematic problems (Van Den Bos, 2011). Human is to error, and that is no exception for pilots. However, pilots do not have direct contact with people as nurses do. Nurses are directly responsible for the lives of patients in that the decisions they make can save a life or lose it altogether. Some of the causes of errors among nurses can easily be avoided or are inapplicable to pilots. For example, with regard to distraction, a pilot can always go on autopilot or have the co-pilot take over the flight; a lack of understanding and knowledge is highly unlikely as pilots take frequent examinations to ensure they are competent in their work and cannot be allowed to fly without clearance; memory lapses again can be mitigated by having the co-pilot take over in case the pilot has memory lapses. However, when it comes to systematic problems, a pilot is as vulnerable as any other passenger. That said, it is the responsibility of aeronautic engineers to make sure that the aircraft is in good working condition before it lifts off. The pilot should also ensure that all the instruments in the cockpit are working and do not present the slightest difficulty in operating them. So, while it is human to error, I would not accept the pilot willingly forego his/her duty to ensure the safety of the aircraft where it concerns him/her to make the checks. Where the realm of inspection is beyond his responsibility, I would not hold the pilot accountable for any accidents or mishaps.
References
Christianson, M. K., Sutcliffe, K. M., Miller, M. A., & Iwashyna, T. J. (2011). Becoming a high reliability organization. Critical Care, 15(6), 314.
Chassin, M. R., & Loeb, J. M. (2013). High‐reliability health care: getting there from here. The Milbank Quarterly, 91(3), 459-490.
Riley, W., Davis, S. E., Miller, K. K., & McCullough, M. (2010). A model for developing high‐reliability teams. Journal of nursing management, 18(5), 556-563.
Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., & Shreve, J. (2011). The $17.1 billion problem: the annual cost of measurable medical errors. Health Affairs, 30(4), 596-603.
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Question 
High Reliability Organizations
As a registered nurse, I worked in a busy Cardiac Care Unit, as well as a floating Pediatrics Emergency Department, Intensive care unit, Surgical Intensive Care Unit, Medical Surgical Unit, and Behavioral Health Unit. The responsibility of the registered nurse before administering medication to a patient is to ensure safety checks by reviewing the six rights and three checks of medication administration. The five rights refer to the right patient, right medication, right dose, right route and the right time. It is critical to follow the checks to administer medications to prevent harm and to maintain patient safety. A registered nurse must not forget the three checks in medication administration. First, it is crucial to check the medications when they are pulled from an automated dispensing machine, medication drawer, or a system in place at the institution. The second check is when the preparation of the medications for administration takes place. Lastly, the final check is at the patient’s bedside right before the medication is given to the patient. It is a place where I teach the patient about the medication.
The registered nurse cannot solely rely on the pharmacy or the prescribing doctor to safeguard the patient from medication errors. I have encountered situations where either the doctor prescribed the wrong medication or the pharmacy sent the wrong medication, or the correct medication but the incorrect dosage. I believe the healthcare organization failed to ensure that the checks and balances put in place were implemented. It is one thing to have hospital procedures and policies and another to implement them. So, while the Cedars Sinai Hospital has the policies in place, they failed repeatedly, eight times to be exact, to ensure that the policies were followed to the letter. There is a moral failure in this case because the hospital is mandated to take care of the twins at the NICU, yet the caregivers were negligent, and their actions led to malpractice (Oyebode, 2013). The lives of the twins are on the line because of the negligence of the hospital staff.
For patients to fill a medical malpractice lawsuit, they need to ensure the situation meets the 4Ds of criteria: duty, dereliction, direct causation, and damages (Preskorn, 2014). When there is a relationship between a doctor and the patient, specific rules and expectations need to be followed and met about competence. A doctor should treat the patient with respect and confidentiality and listen to the patient. If a doctor cannot help, he/she should refer the patient to another doctor. Dereliction refers to a situation where the doctor does something wrong such as giving the wrong medication. Direct causation refers to the negative outcome that arises from dereliction. Medical records are used as evidence of causation. Lastly, damages refer to the monetary amount needed to address the harm caused to the patient’s body, the patient’s way of life and psychological well-being. The lawsuit may cite suffering, pain, and emotional distress, among others (Preskorn, 2014). In this case, the hospital presumably made it known to the parents that they would take care of the twins and took up the duty to do so. However, the hospital is guilty of dereliction as the wrong dose of heparin was prescribed.
The Plaintiffs have the right to pursue a claim against the hospital because the latter was negligent in caring for the two patients. The twins were already in a very vulnerable state, seeing that they were born prematurely. Heparin was necessary for their care, but the amount administered was more than 1000 times the standard dose and was highly lethal and life-threatening. The current life-threatening situation can be argued as a direct cause of the hospital’s dereliction. At the time of the reporting, the life status of the patients hangs in the balance, and if lost, the hospital should be sued for a double homicide. The plaintiff should sue for negligence, malpractice, distress, and any other related offences (Walker, 2011). The parents should seek to be awarded damages for the physical harm caused to the twins as well.
Hospitals of all types need to engage in approaches that are systematic in identifying and preventing adverse events and medical errors. The safety and quality of leaders in hospitals have several opportunities to fulfil their obligations in building patient safety systems. When hospital quality leaders are lax in meeting these obligations, it is expected that medical errors will recur, and what follows are poor patient outcomes and subsequent lawsuits (James, 2013). In this case, getting back to patient safety is not an ‘if’ option to criminal actions. Criminal actions should be taken, and patient safety should be addressed. Addressing patient safety rather than taking legal action is only a moral defence if the offence committed is a first-time occurrence (Dekker, 2016). However, where the offence is repeated several times, legal action should be taken to ascertain that the recurrence of the crime is curtailed permanently.
As a medical professional, I understand that it is critical to honour the biblical worldview in line with ethical integrity and medical professionalism to prevent medication errors and to protect human life. Medical professionals must abide by the checks and balances in place in a medical facility or organization in order to weigh the benefits with the risk of not seeking support and guidance when a medical decision is questionable. Jesus’ affirmation of divine love, through atonement and love, exemplifies the unity of man with God through Christ Jesus. We acknowledge man is saved through Christ, through life, through Truth, and Love, as seen by the Galilean Prophet overcoming sin and death and healing the sick. (1 John 4:6, ) We are from God; Jesus, who knows God, listens to us; he who is not from God does not listen to us. By this, we know the spirit of truth and the spirit of error.
Thank you
God Bless
References
Dekker, S. (2016). Just culture: Balancing safety and accountability. CRC Press.
James, J. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128.
Oyebode, F. (2013). Clinical errors and medical negligence. Medical Principles and Practice, 22(4), 323-333.
Preskorn, S. H. (2014). Clinical Psychopharmacology and medical malpractice: the four Ds. Journal of Psychiatric Practice®, 20(5), 363-368.
Walker, R. (2011). Elements of negligence and malpractice. The Nurse Practitioner, 36(5), 9-11.
RE: Responsibility in Health Care
But how do medical errors even exist since nurses do the 5 Rights?
Would you accept your airline pilot to behave the same way with the large number of checks needed before take off? How is that any different, they are human And to error I sent human, right?
Before you answer, define what the literature calls a High Reliable Organization and in what industries have successfully transitioned to being a HRO. Why is healthcare any different? Should it be?
Dr Hudson