Healthcare personnel’s views and experiences regarding factors that support or hinder the implementation of concepts, strategies and principles associated with High-Reliability Organisations within healthcare settings

Abstract

Background: High-Reliability Organisations (HROs) are organisations in other industries that operate in high-hazard, complex environment and succeed in accomplishing their goals with avoiding potentially catastrophic errors. In healthcare, the Institute of Medicine released two markable reports on medical errors almost two decades ago. Since then, healthcare organisations have strived to improve patient safety by reducing preventable errors and to be HRO. However, the frequent occurrence of preventable adverse events is inconsistent with the characteristics of HRO. Aim: To identify barriers and enablers to the implementation of HROs' principles and strategies as viewed and experienced by stakeholders in healthcare. Methods: A qualitative evidence synthesis (QES) approach was undertaken to answer the review's question. A search was conducted using a previously-defined strategy in five electronic databases (ASSIA, CINAHL, MEDLINE, HMIC and WEB OF SCIENCE), in addition to which one grey-literature database was used and hand searching was also undertaken to locate all relevant studies. Then, the eligibility assessment was carried out according to specified inclusion and exclusion criteria. The eligible studies were critically appraised by using the CASP (2018) checklist for qualitative research. Line-by-line coding was done to extract the findings before synthesizing using a thematic approach. Results: Nine studies were included. They generated 364 findings, which were grouped into 64 descriptive themes and ten analytical themes, namely culture; reporting and sharing information; training; motivation; standardization; reluctance to simplify; sensitivity to operations; commitment to resilience; deference to expertise; constraints; and resources that effect safety. Conclusion: The review demonstrated that stakeholders deem high-reliability as synonymous with embedding a safety culture. The key facilitators were: excellent education and training; spreading the safety culture across all the organisation; influential leaders; effective communication; teamwork; foster reporting; analysing incidents; motivating staff; introducing forms and checklist and standardised procedures; and empowering frontline staff with the expertise to make decisions. The barriers were: the lack of knowledge; miscommunication; the complexity of the system; the financial and other resources constraints.