Assessment of High Reliability Organizations Model in Farabi Eye Hospital, Tehran, Iran.

BACKGROUND: A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015-2016. METHODS: In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman's correlation coefficient and Mann-Whitney test using the SPSS software version 19. RESULTS: Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital. CONCLUSION: Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.

Implementation of clinical governance in hospitals: challenges and the keys for success.

There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.