To prevent medical errors from affecting patients—and minimizing the harm caused when they do—Helen DeVos Children's Hospital has introduced “high reliability units” in several higher-risk patient-care areas based on evidence-based practices.

These units at the 200-bed facility have undergone safety-based staff training, adopted multiple quality and safety metrics, created a safety leadership infrastructure and encouraged transparency when it comes to safety events. They focus on the five principles of high reliability: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience and deference to expertise.

This has resulted in metrics such as an estimated 68% decrease in serious safety events; an increase in hand hygiene compliance rates from 56% to 95%; zero cases of ventilator-associated pneumonia in the pediatric intensive-care unit for 22 straight months and only one such case in the neonatal ICU in two years; and 100% compliance with asthma core measures for seven out of 10 months. These results and efforts have earned Helen DeVos the Spirit of Excellence Award in the new Patient Safety category.

“It had a lot to do with building infrastructure, teams, metrics and different leadership components. That was the laying of the foundation for developing the culture,” says Dr. Tom Peterson, executive director of safety, quality and community health for Helen DeVos in Grand Rapids, Mich.

“You really can't do this without having the appropriate culture for it,” he says. “It's basically having people who are comfortable, having nurses who can talk to doctors, people from security who can talk to executives—an open, teamwork-based culture.”

Helen DeVos faced challenges after launching the project in May 2010 in getting physicians interested and making nurses and residents comfortable, Peterson says.

“The way doctors have been trained, it's a sign of weakness if they talk to other people or ask for assistance,” he says. “It's everything down to hand-washing. If the director of the department doesn't wash his hands, and you're a tech on the floor, you've got to be able to speak up and mention that to them.”

Robert Marrone, quality specialist, recalls when a nurse noticed that a resident had prescribed a medication for the wrong patient and respectfully pointed it out. “The resident realized what he had done, corrected it and wrote an instant report citing himself,” Marrone says. “He was comfortable enough to listen to the nurse, correct the error and document the incident because he knew the chief resident was going to support him for properly documenting the error.”