Measuring psychological safety and local learning to enable high reliability organisational change.

The ability to measure the extent to which an organisation is highly reliable, or the extent to which reliability may change over time, has not kept up with the development of theory. The paper examines aspects of workplace culture, employee motivation and leadership behaviours that support continuous learning and improvement in an effort to measure the transition to high reliability.To evaluate the effectiveness of its high reliability initiative, one children's hospital sought to build measures that would provide an assessment of progressive movement towards a 'culture of safety', and track the success over time. This paper reports on the development of two scales (trust in team members and trust in leadership) that are intended to measure two cultural conditions fostered by the five high reliability principles and a composite measure on local learning activities. The two scales are strongly associated with local learning activities in employees' work areas and with employees' willingness to participate in extra role activities. We suggest that they are foundational to creating a psychologically safe environment and thus to becoming a high reliability organisation.

The Child Health PSO at 10 Years: An Emerging Learning Network.

INTRODUCTION: The 2005 Patient Safety and Quality Improvement Act, actualized as a Learning Network (LN), has enabled the Child Health Patient Safety Organization (PSO) to play a vital and novel role in improving the quality and safety of care. This article describes the Child Health PSO and proposes PSOs as a new construct for LNs. METHODS: A PSOs ability to affect patient care depends on member organizations' integration of PSO output into their individual Learning Healthcare Systems. Therefore, the Child Health PSO developed tenets of an LN to improve member engagement in PSO outputs. RESULTS: All Child Health PSO members participate in case-based learning, requiring ongoing and robust participation by all members. The engagement has been strong, with 86% of children's hospitals achieving a case learning activity metric and 60% of children's hospitals submitting cases. From this LNs perspective, 53% of children's hospitals are considered highly engaged. CONCLUSIONS: In the last 10 years, the Child Health PSO has evolved as a viable LN and, to sustain this, has set a target of 100% of participating children's hospitals being highly engaged. The previously inconceivable notion of sharing information to improve patient safety among hospitals is now an expected result of the formation of trusting relationships under a federally certified PSO. According to participants, collaboration is an essential element that empowers individual children's hospitals to eliminate preventable harm.

Use of Simulation to Test Systems and Prepare Staff for a New Hospital Transition.

OBJECTIVE: To describe the development and key outcomes arising from the use of simulation as a method to test systems and prepare staff for a transition to a new hospital. METHODS: We describe a simulation program developed by key parties with the goal of reducing latent safety threats present at the opening of a new hospital and to train staff in new workflows. Issues identified were collected and reported to leadership. Outcomes included the number of learners reached, issues identified (grouped by theme), and results of a postmove survey of hospital-based staff. RESULTS: Approximately 258 hours of simulation were conducted, impacting 514 participants. We conducted 64 hours of system testing and 196 hours of training during the main orientation process. Approximately 641 unique issues were identified (175 equipment, 136 code alarm, 174 barriers to care, and 156 incorrect signage). In a hospital-wide survey, 38% reported simulation as part of their training (39% of nurses and 23% of physicians). 43% of survey respondents reported multidisciplinary simulations; 55% of simulation attendees felt that the simulation was helpful and eased their transition to the new hospital. CONCLUSIONS: Systems testing and education using simulation can play a meaningful role in new facility training. Key lessons included early planning, allocation of resources to the effort, flexibility to adapt to changes, and planned integration with other training activities. A formal a priori plan to address issues identified during the process is necessary.