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HRO Corner: Army Focuses on Leadership, Collaboration to Improve Patient Safety

Medical professionals gather in hospital hallway to huddle. Regular communication through leadership engagement, team huddles and debriefs are proven strategies to strengthen teamwork and the quality of health care.

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The journey to transforming the Military Health System into a high reliability organization requires teamwork and adoption of high reliability principles. The Army’s high reliability journey is focused on all three high reliability organization pillars: continuous improvement, culture of safety, and leadership commitment.

Foster Learning

The Army is beginning to conduct quarterly Patient Safety Forum meetings that enable all military treatment facility commanders in each region to gather and share specific patient safety challenges in their facility and what is being done to improve care.

“We are tracking metrics for wrong site surgery, unintended retained foreign objects, and the use of radio-frequency identifications,” said Maj. Jose Tirado, deputy director for HRO for the Army. “We want to learn why something happened and share the lessons learned across the Army. We had our first meeting Feb. 8. We learned two commanders at different military treatment facilities are experiencing similar challenges and they are now coordinating with a working group to identify solutions.” 

The Army is also using a Root Cause Analysis Event Support and Engagement Team (RESET) to support Army Medicine’s quality improvement efforts. RESET provides short term assistance to an MTF that may have experienced an adverse medical or dental event and helps to identify the root cause of the event. 

“This is a non-punitive effort to get a clearer understanding of what happened, gather data and push out the findings to all the regions so if they are facing similar problems, they can use this information to help mitigate the risk of patient harm,” Tirado said. “It’s done very well and has been going strong for almost two years. We’re getting a lot of data and changing policies as necessary along the way, which is improving care for our patients.”

Leadership Engagement

Incorporating the strategies within the MHS Leadership Engagement Toolkit has been a priority for the Army. To encourage commanders to implement unit-based huddles and daily safety briefings into local MTF schedules, the Army launched an Army Medical Command HRO Unit-Based Safety Huddle Competition in 2017. MTFs were encouraged to submit their processes for using these huddles and briefings on a regularly basis. 

HRO Guiding Principles graphic

A total of 73 entries were received across the Army Medical Command. The competition was designed to assess where the Army is right now with patient safety focuses, identify best practices and share those across the Army. 

Though many clinics were performing huddles, the competition team found that many key elements were missing, including a safety focus, the use of a standardized tool, the tracking and trending of safety findings and celebrating success. As a result, the team incorporated these findings into an operation order to provide the standard elements of a Unit-Based Safety Huddle. The expected publication and dissemination to MTFs is spring 2018. 

“These competitions are a way to get everyone energized and focused on the road toward high reliability,” Tirado said. “We’re looking to host more competitions like this in the future.”

General Leonard Wood Army Community Hospital at Fort Leonard Wood won first place for both clinical and non-clinical units. Womack Army Medical Center at Fort Bragg was the runner-up for both the clinical and non-clinical unit categories. Winn Army Community Hospital at Fort Stewart was the winner for the best overall MTF Team Huddle Engagement.

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