A Shared Experience: Approaches to High Reliability Organization Implementation in Two U.S. Federal Healthcare Systems (29H)

To support service members, veterans and their families in receiving the highest quality healthcare, the Defense Health Agency (DHA) and the Veterans Health Administration (VHA) each embarked on respective, yet complementary, journeys to become high-reliability organizations (HROs). Both systems embraced and deployed similar leading industry strategies to accelerate the adoption and sustainment of HRO behaviors and practices. VHA has been a leader in the patient safety movement for more than two decades and is capitalizing on that momentum through HRO. In 2019, VHA launched an enterprisewide HRO transformation initiative and made a long-term strategic commitment to pursuing zero harm. As each organizational level of the VHA system advances in HRO maturity, leaders actualize this commitment to zero harm by strengthening organizational safety culture. Likewise, after a comprehensive review of Military Health System (MHS) performance in 2014, the MHS took action to improve systemwide access, quality, patient safety, transparency and patient engagement. Under DHA, the impetus for HRO expanded to standardize and spread these efforts by applying a coordinated approach to HRO transformation under the Ready Reliable Care (RRC) brand enterprisewide. Not only is RRC embedded in clinical settings but also encompasses nonclinical settings to drive better outcomes for patients, staff and employees.

The aim of this first-ever VHA-DHA combined session is to outline a shared experience aligning strategic initiatives and infrastructure supporting each system on its journey to high reliability and illustrate approaches based on differences in organizational culture, patient populations and the complexity of care delivery, which is universally applicable to all healthcare organizations in the federal or nonfederal space.