Journal Article

How reliable are clinical systems in the UK NHS? A study of seven NHS organisations.

Burnett S, Franklin BD, Moorthy K, et al. BMJ quality & safety. 2012;21:466-72.

One key characteristic of high reliability organizations is maintaining sensitivity to operations—understanding of and attentiveness to issues faced by frontline workers. While maintaining a culture of safety is an important facet of attending to frontline workers' concerns, a more mundane but equally important aspect is ensuring that workers can reliably complete their tasks. This survey of seven National Health Service hospitals found poor task reliability across several clinical processes. For example, essential operating room equipment was unavailable in up to 37% of cases at one hospital, and at another, clinical information was missing for 27% of patients being seen in an outpatient clinic. Missing equipment or information leads to interruptions in performing tasks, which have been linked to increased rates of adverse events. Some hospitals did achieve higher reliability, and the authors cite standardization of processes as one factor leading to improved reliability.