High Reliability Organizations

A high reliability organization (HRO) achieves top outcomes despite operating in complex or high-risk environments.

The airline and nuclear industries are common examples of HROs. They get top results by:

• Standardizing processes for less variability
• Reducing errors to achieve zero harm in clinical and non-clinical areas
• Celebrating transparency and accountability
• Valuing everyone's input, regardless of rank

After a review of MHS performance in 2014, each service medical department and the DHA took specific action to improve health care access, quality, safety, transparency, and patient engagement. Now the DHA is working to standardize and spread these efforts, in a coordinated path to high reliability for the entire MHS: Ready Reliable Care.

Ready Reliable Care Principles

The seven principles of Ready Reliable Care guide our work and apply to all staff, in every job. When we use these principles in our work, we advance high reliability:

PREOCCUPATION WITH FAILURE Drive zero harm by anticipating and addressing risks	SENSITIVITY TO OPERATIONS Be mindful of how people, processes, and systems impact outcomes	DEFERENCE TO EXPERTISE Seek guidance from those with the most relevant knowledge and experience	RESPECT FOR PEOPLE Foster mutual trust and respect

COMMITMENT TO RESILIENCE Leverage Past mistake to learn, grow, and improve processes	CONSTANCY OF PURPOSE Persist through adversity towards the common goal of zero harm	RELUCTANCE TO SIMPLIFY Strive to understand complexities and address root causes

Ready Reliable Care Domains of Change

By using the Ready Reliable Care principles in our daily work, all staff contribute to a more ready and reliable MHS. System-wide progress happens across four domains of change:

LEADERSHIP COMMITMENT Prioritize Ready Reliable Care at all levels of leadership	CULTURE OF SAFETY Commit to safety and harm prevention	CONTINUOUS PROCESS IMPROVEMENT Advance innovative solutions and spread leading practices	PATIENT CENTEREDNESS Focus on patients' safety and quality of care experience

Do you know someone who is contributing to a more highly reliable MHS and advancing the DHA mission by embodying Ready Reliable Care principles in their daily work? Nominate them, as part of the DHA Director Spotlight recognition program.

Clinical Improvement Priorities for Military Hospital and Clinic Providers

Ready Reliable Care efforts span all four domains of change noted above. This year, we are focused on several projects to support continuous process improvement in the clinical care setting. They include:

• Stepped Care Model for Pain: This model will allow military hospitals and clinics to standardize and effectively implement evidence-based best practices for managing acute and chronic pain in the primary care setting.
• Opioid Overdose / Naloxone Distribution: Through standardized management of chronic pain, this program will ensure that patients taking long-term opioid therapy with an elevated risk of opioid-related harm, receive overdose education and at least one prescription for naloxone medication in a 12-month window.

For other clinical priorities, visit the page for clinical improvement priorities for military hospital and clinic providers