The Relationship between High-reliability practice and Hospital-acquired conditions among the Solutions for Patient Safety Collaborative

Theoretically, the application of reliability principles in healthcare can improve patient safety outcomes by informing process design. As preventable harm continues to be a widespread concern in healthcare, evaluating the association between integrating high-reliability practices and patient harms will inform a patient safety strategy across the healthcare landscape. This study evaluated the association between high-reliability practices and hospital-acquired conditions. METHODS: Twenty-five pediatric organizations participating in the Children’s Hospitals Solutions for patient safety collaborative participated in this nonexperimental design study. A survey utilizing the high-reliability healthcare maturity model assessed the extent of implementing high-reliability practices at each participating site. We analyzed responses for each component and a composite score of high reliability against an aggregate measure of hospital-acquired conditions. RESULTS: Of the 95 invited sites, 49 responded and 25 were included in the final results. There was a significant inverse relationship between the culture of safety component score and the Serious Harm Index (odds ratio [OR] = 0.63, 95% confidence interval [CI] 0.42–0.95, P = 0.03). There was no association between the overall high-reliability score (OR = 0.91, 95% CI 0.78–1.05, P = 0.19), the Leadership component score (OR = 0.97, 95% CI 0.70–1.33, P = 0.84), or the robust process improvement (RPI) component score (OR = 0.75, 95% CI 0.41–1.28, P = 0.26) and the Serious Harm Index. CONCLUSION: The integration of high-reliability principles within healthcare may support improved patient safety in the hospital setting. Further research is needed to articulate the breadth and magnitude of the impact of integrating high-reliability principles into healthcare.