As part of Cooper University Health Care’s involvement in the New Jersey High Reliability Organization (HRO) Collaborative, also known as New Jersey S.T.R.O.N.G., our goal is to train and educate staff on how to provide the best care to our patients in the safest environment.
An important aspect of providing safe care to our patients is learning from near miss events. When an incident that might have resulted in harm to a patient is avoided because of the timely intervention of health care providers, it is considered a near miss event.
Preoccupation with failure is a key principle that HROs employ to predict and eliminate catastrophes, rather than reacting to them. When near misses occur, we view them as an opportunity to improve operations, rather than as proof that there are enough checks in place to prevent a catastrophic failure. HROs never ignore a failure, no matter how small, because any deviation from the expected result can snowball into tragedy.
Other fields that use preoccupation with failure to avoid significant failure or catastrophic events include:
- Energy companies
- Aviation and transportation
- Military and space
- Fire/disaster responders
- Educational institutions
It’s important to remember that near miss events are often caused by a series of errors – not paying attention, distractions, interruptions, and poor communications. When we make mistakes, the best checks and balances are other team members. Everybody has a part to play in keeping our patients safe – clinical and non-clinical people alike. Changing our habits makes us more reliable and less at risk for human error.
To schedule a training session, visit the Cooper Learning Network and search for “High Reliability Organization (HRO) Staff and Physician Training.”