ABSTRACT
BACKGROUND: To prevent patient harm, health care organizations are adopting practices from other complex work environments known as high-reliability organizations (HRO). PURPOSE: The purpose was to explore differences in manifestations of HRO principles on hospital units with high and low safety performance. METHODS: Focus groups were conducted on units scoring high or low on safety measures. Themes were identified using a grounded theory approach, and responses were compared using qualitative thematic analysis. RESULTS: High performers indicated proactive responses to safety issues and expressed understanding of systems-based errors, while low performers were more reactive and often focused on individual education to address issues. Both groups experienced communication challenges, although they employed different methods of speaking up. CONCLUSION: Some HRO principles were present in the language used by our participants. High performers exhibited greater manifestations of HRO, although HRO alone was insufficient to describe our results. Mindful organizing, which expands on HRO, was a better fit.
Subject(s)
Patient Safety/standards , Quality of Health Care/standards , Adult , Female , Focus Groups/methods , Grounded Theory , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
This study explored similarities and differences in the views on team membership and leadership held by nurses in formal unit leadership positions and direct care nurses. We used a mixed-methods approach and a maximum variance sampling strategy, sampling from units with both high and low safety behaviors and safety culture scores. We identified several key differences in mental models of care team membership and leadership between formal leaders and direct care nurses that warrant further exploration.
