Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods

Abstract

ObjectivesWithin the last 2 decades, numerous interventions making use of high-reliability theory have been implemented to increase reliability in healthcare organizations. This systematic literature review first explores the concrete goals on which such interventions focus. Second, the review captures how the achievement of these goals, or alternatively a change, generally an increase in organizational reliability, is measured across different contexts.MethodsSearches were conducted in PubMed, Academic Search Ultimate, Business SourcePremier, CINAHL, Communication Source, EconLit, ERIC, Medline, Political Science Complete, PsycArticles, APA PsycInfo, PSYNDEX, SocINDEX (via the resource hosterEbscoHost), and Web of Science (through November 22, 2021). Peer-reviewed, English language studies were included, reporting on the implementation of a concrete intervention to increase reliability in a medical context and referring to high-reliability theory.ResultsThe search first yielded 8896 references, from which 75 studies were included in the final sample. Important healthcare goals stated by the seminal report “Crossing the Quality Chasm” guided the analysis of the included studies. Most of the studies originated from the United States and report on interventions to increase reliability of either organizational units or whole organizations when aiming for safety (n = 65). Other goals reported on include effectiveness, and much less frequently timeliness, patient centeredness, and efficiency. Fifty-eight studies use quantitative measurement exclusively to account for the achievement of these goals; 7 studies use qualitative measurement exclusively, and 10 studies use a mixed-method approach. The operationalization of goals, including the operationalization of organizational reliability, and measurement methods do not follow a unified approach, despite claiming to be informed by a coherent theory. Instead, such operationalizations strongly depend on the overall objective of the study and the respective context.ConclusionsMeasuring the outcomes of high-reliability interventions into healthcare organizations is challenging for different reasons, including the difficult operationalization of partly overlapping goals, the complex, processual nature of achieving reliability, and the limited ability of organizations striving for more reliability if they are already performing on a high level. This review critically assesses the adoption of the goals stated in the seminal report “Crossing the Quality Chasm” and provides insights for organizations and funding providers that strive to evaluate more reliable service provision.

Untitled

“…>> Organisationsforscher:innen definieren Zuverlässigkeit meist als "die ungewöhnliche Fähigkeit, kollektive Ergebnisse mit einer bestimmten Minimalqualität kontinuierlich zu produzieren" (Hannan/ Freeman 1984, S. 153). Dabei kann das kollektive Ergebnis in der Praxis unterschiedlich ausgestaltet sein (Ramanujam 2018;Auschra et al 2022): Typischerweise handelt es sich um das Erreichen von Sicherheit -sowohl in klassischen HROs wie Atomkraftwerken als auch im Gesundheitssektor. Weitere mögliche, zuverlässig zu erreichende Ziele sind u.a.…”

“…Eine Vielzahl von Interventionen, v.a. in Krankenhäusern, zielte darauf ab, eine Kultur der Hochzuverlässigkeit zu erschaffen oder bestimmte Prozesse mit Blick auf Ziele wie die Patientensicherheit reliabler zu gestalten (Tolk et al 2015;Auschra et al 2022).…”

Hochzuverlässigkeitstheorie

“…>> Organisationsforscher:innen definieren Zuverlässigkeit meist als "die ungewöhnliche Fähigkeit, kollektive Ergebnisse mit einer bestimmten Minimalqualität kontinuierlich zu produzieren" (Hannan/ Freeman 1984, S. 153). Dabei kann das kollektive Ergebnis in der Praxis unterschiedlich ausgestaltet sein (Ramanujam 2018;Auschra et al 2022): Typischerweise handelt es sich um das Erreichen von Sicherheit -sowohl in klassischen HROs wie Atomkraftwerken als auch im Gesundheitssektor. Weitere mögliche, zuverlässig zu erreichende Ziele sind u.a.…”

“…Eine Vielzahl von Interventionen, v.a. in Krankenhäusern, zielte darauf ab, eine Kultur der Hochzuverlässigkeit zu erschaffen oder bestimmte Prozesse mit Blick auf Ziele wie die Patientensicherheit reliabler zu gestalten (Tolk et al 2015;Auschra et al 2022).…”