A Journey to High Reliability

Kina’Ole: The Right Thing, for the Right Reason, with the Right Feeling

To err is human. To reduce errors through the practice of mindfulness and shared accountability: that is high reliability. High reliability is not a new concept, but its adoption in health care is only occurring among the innovative. Hackensack Meridian Health is one of those innovators, with an approach that brings high reliability and the patient experience together, transforming us into a high reliability organization – or an HRO.

What is an HRO? It is an organization that is involved in a complex and high-risk environment that delivers exceptionally safe and consistently high-quality service/care over time.

No doubt you have interacted with highly reliable organizations in your travels – literally.

The airline industry has practiced high reliability for decades. Though a pilot may be on their thousandth flight, they diligently runs through their pre-flight checklist. This tool helps him to be in the moment, be mindful, focus only on the task at hand and recognize potential for error before it might happen. Further, his co-pilot and flight crew feel very comfortable offering feedback or questioning a decision they feel might cause error or, even worse, harm.

These same principles can be applied to health care. Just like the airline industry, health care safety and quality can be improved through the practice of mindfulness, the use of tools and checklists that turn behaviors into habits and a preoccupation with failure so strong that the team always feels comfortable and supportive in speaking up to prevent errors.

We believe in quality, safety, empathy and respect. We also share the belief that with high reliability as our operating system, the outcome will be a safe and exceptional experience for every patient, every place, every time.

At Hackensack Meridian Health, we feel the spirit of our high reliability transformation can be captured in one word: Kina’ole. This Hawaiian word is defined as “the highest form of flawlessness or excellence.” We can think of no better way to describe our goal.

To date, over 16,000 team members have been trained in the principles of high reliability to ensure we are always doing the right thing in the right way at the right time in the right place with the right person for the right reason with the right feeling, the first time and every time.

Goal Zero: Achieving Zero Infections Across the Network

In the same vein as high reliability, infection prevention plays a major role in ensuring we are delivering the best patient care while making sure we consistently deliver zero patient harm. Nearly two years ago, Legacy Meridian Health set a goal to achieve zero infections and zero patient harm. To achieve this goal, a committee was formed to evaluate best practices and implement evidence-based care in order to create checklists and best-care bundles.

To date, the incidence of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs) and sepsis has dramatically decreased in our hospitals. By focusing on these health care-associated infections, we know that we can accelerate change and improvements and continue to fulfill our promise of providing the best health care experience.

Goal Zero
Teams at Raritan Bay Medical – Perth Amboy and Old Bridge were honored for being CAUTI-free for over two years on Division 3 Green and Pediatrics at Raritan Bay Medical Center – Perth Amboy; and Division Med Surg 2 and 4 Telemetry at Raritan Bay Medical Center – Old Bridge, as well as being CLABSI-free for two years on Division 3 Green and Pediatrics at Raritan Bay Medical Center – Perth Amboy; and Division 4 Telemetry at Raritan Bay Medical Center – Old Bridge.

While all of our hospitals have made significant progress in reducing infections and improving care, some of our hospitals have made substantial strides in their quality efforts. For example, since the launch of Goal Zero two years, Southern Ocean Medical Center is both CLABSI and CAUTI free since February of 2016. Additionally, the following units have gone two years without a CAUTI: 4 Med Surg at Southern Ocean Medical Center; 2 North, 4 East/West, 4 South, and 3 East at Bayshore Medical Center; Mehandru 7 and Pediatrics at Jersey Shore University Medical Center; 5 West and 3 East at Riverview Medical Center; Division 3 Green and Pediatrics at Raritan Bay Medical Center – Perth Amboy; and Division Med Surg 2 and 4 Telemetry at Raritan Bay Medical Center – Old Bridge.

Equally as impressive is that the following units have gone without a CLABSI for two years: 3 Med Surg at Southern Ocean Medical Center; 4 South at Bayshore Medical Center; Mehandru 7, Pediatrics, the PICU, and the NICU at Jersey Shore University Medical Center; 4 North and 6 West at Ocean Medical Center; 2 North, 5 North, and 5 West at Riverview Medical Center; Division 3 Green and Pediatrics at Raritan Bay Medical Center – Perth Amboy; and Division 4 Telemetry at Raritan Bay Medical Center – Old Bridge.

Goal Zero 2
Southern Ocean Medical Center celebrated being “zero” when they achieved being CAUTI- and CLABSI-free since February 2016.

At Hackensack Meridian Health, we continuously set the bar higher for our quality standards, and we share accountability across our continuum with all of our team members to meet these goals. It is an interdisciplinary effort that encompasses the entire organization – including physicians, nurses, support staff, administration personnel and board members – all working in unison to improve the safety and quality of patient care. Achieving a culture of safety and quality is what distinguishes our organization as a leading health care provider. That’s why we’ve also launched a website, HackensackMeridianHealth.org/Quality that includes up-to-date quality metrics for each of our hospitals, including patient experience, health care associated infections and hospital readmission rates.