How Nurse Accountability Fosters High Reliability and Empowerment

Today’s healthcare system faces many challenges — an increasingly complex patient population, a nursing shortage, and lingering problems from the COVID-19 pandemic, such as supply issues. Each challenge adds a layer of complexity to an already complicated industry, where even the smallest error can result in patient harm. With these challenges, nurse accountability has become a growing topic. 

Patient safety issues involving nurses have been shared in the media recently, some with legal implications that the profession hasn’t previously seen. As nurses generally spend more one-on-one time with patients than other members of the care team, they’re understandably concerned with how they may be held responsible for patient harm from what very well may be a system error.

Patient safety errors

While patient safety errors are not new, the growth of social media and increase in overall communication allows for more stories to be shared. We’re likely hearing about instances of patient safety errors more now than ever before, though they’ve always existed.

In fact, it’s been 20 years since the watershed To Err Is Human report was issued by the Institute of Medicine, which brought national concern about patient safety with its claim that as many as 98,000 people die in U.S. hospitals each year because of preventable medical errors.

Some sobering studies in recent years indicate that To Err Is Human actually underestimated the number of deaths caused by preventable errors. A 2019 analysis reported that an estimated 1.2 million are harmed each year by medical errors made in U.S. hospitals.

Research suggests that hospitals can take 17 years to adopt evidence-based best practices. How then can nurses and other caregivers contribute to advancing patient safety?

Eliminating patient harm

To combat patient safety errors, organizations focusing on healthcare quality improvement have developed and promoted frameworks for hospitals and health systems to adopt. One thing we’ve learned over the last two decades of research and practice is that improving patient safety is a complex, multifaceted problem, which won’t be solved by piecemeal, ad hoc initiatives. Instead, moving the needle on patient safety requires a total systems approach and, first and foremost, the creation of a strong culture of safety within an organization.

With many quality improvement frameworks to choose from, one approach has sustained popularity and proven to improve patient safety — the concept of high reliability. While high reliability has been prevalent in other industries for many years, it’s truly picking up speed in the healthcare industry. The effort to create a culture of high reliability within health care is not only long overdue but encompasses the key elements to help organizations focus on what really matters when improving patient safety.

High reliability organizations use systems thinking to evaluate and design for safety, while acutely aware that safety is an imminent, changing threat. New safety risks continuously emerge, uncertainty is everywhere, and no two accidents are the same. Knowing this, high reliability organizations (HROs) aim to create an environment in which potential problems are …read more

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