Creating Highly Reliable Health Care

Hospitals are increasingly looking to new work practices and processes to reduce the epidemic of medical errors. The authors examine one such innovative approach emulating high-reliability organizations (e.g., nuclear power plants) that use a combination of specific work practices and behavioral processes to detect and adapt to unexpected events to operate in a nearly error-free manner. They explore whether and how reliability-enhancing work practices (REWPs) help enable such processes and improve performance (i.e., reduce errors). Using survey and archival data from 1,685 registered nurses and 95 nurse managers in 95 hospital nursing units, the authors examine how REWPs affect a set of attitudinal (affective commitment and organizational citizenship behavior) and discursive (respectful interaction and mindful organizing) processes and, in turn, patient safety. They find the greater use of REWPs are directly and indirectly (through respectful interaction and mindful organizing) associated with fewer medication errors and patient falls. In contrast, organizational citizenship behavior was associated with more medication errors and patient falls.