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41003Assignment: High Reliability in Health Care – Long-Term Care
There are three imperative steps that need to be taken. The first is a strong commitment by leadership to this very high level of safety and quality. The leadership must set the goal and example for everyone in order to achieve high reliability. The second is to embed all of the principles and practice of a culture of safety throughout the organization which emphasizes trust, reporting of unsafe conditions, and highly effective improvement over time. The third step is to utilize powerful Robust Process Improvement tools like Six Sigma, Lean, and change management to create near perfect processes, similar to the tools that we see in industries like commercial aviation today, and sustain very high levels of safety over long periods of time.
—Dr. Mark R. Chassin
These three steps: commitment by leadership, development of a culture of safety, and the use of process improvement tools, are the core recommendations made by Dr. Chassin, the president of The Joint Commission and the president of the Joint Commission Center for Transforming Healthcare. A first step in identifying whether these recommendations are being met is to compare elements of an organization to criteria which have been identified as essential to high-reliability organizations.
To prepare for this Assignment:
Consider the three steps described by Dr. Chassin and the seven major criteria of the Baldridge Performance Excellence Program, and reflect on how these recommendations can apply to health care organizations, specifically to long-term care facilities.
The Assignment:
In this Assignment you will identify major elements of high-reliability organizations providing long-term care. According to the Baldrige Performance Excellence Program (MBNQA), the criteria are as follows:
Leadership
Strategic planning
Customer and market focus
Measurement, analysis, and knowledge management
Human resource focus
Process management
Business/organizational performance results
Using the Highly Reliable Organization Matrix located in this week’s Learning Resources, complete the matrix by typing in the elements which meet the criteria in rows and columns. Describe each element briefly, give an example as to how this can be met in a long-term care facility, and explain the expected impact on patient care.
Based on the results of the Highly Reliable Organization Matrix, write a 1- to 2-page executive summary to the board of directors of the long-term care organization, describing elements which meet the criteria from the matrix and how any missing elements of the criteria for excellence can be met.

Sources to help with assignment:
https://www.nist.gov/baldrige
National Institute of Standards and Technology (NIST). (2015c). Baldrige performance excellence program. Retrieved from http://www.nist.gov/baldrige/

Schoenberg, M., Heider, F., Rosenthal, J., Schwartz, C., & Kaye, N. (2015). State experiences designing and implementing Medicaid delivery system reform incentive payment (DSRIP) pools. Retrieved from http://www.statecoverage.org/files/NASHP_Designing_and_Implementing_DSRIP.pdf

Hayes, C. W., Batalden, P. B., & Goldmann, D. (2015). A ‘work smarter, not harder’ approach to improving healthcare quality. BMJ Quality & Safety, 24(2), 100–102. Retrieved from http://qualitysafety.bmj.com/content/24/2/100.full
A ‘work smarter, not harder’ approach to improving healthcare quality by Hayes, C. W., Batalden, P. B., & Goldmann, D. in BMJ quality & safety, 24(2). Copyright 2015 by BMJ Publishing Group Limited. Reprinted by permission of BMJ Publishing Group Limited via the Copyright Clearance Center.

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