High Reliability Care: At the Intersection of Policy and Practice

Health care organizations in the United States struggle to maintain safety and provide quality patient care. In a complex policy environment, the Joint Commission has directed its efforts toward helping health systems achieve high reliability health care. Heath care organizations, facing both accreditation imperatives and political challenges, are mired in the uncertainty of resource availability. The challenges of high reliability in a high stakes industry elude even the most seasoned CEOs and administrators. In particular, it is essential at this time is to pinpoint how public health policy, when coupled with development of high reliability culture, informs implementation of quality and safety at the local level and advances Joint Commission directives related to high reliability care. This theoretically focused paper explores the phenomena of quality and safety from the vantage of two differing lenses, practice and policy. The theoretical analysis of high reliability health care (policy, organizational structure, and actors) contributes to further understanding the challenges facing high reliability patient care implementation throughout hospital systems in the United States. Discussion highlights appropriateness of model fit, whether a top down approach to patient care is realistic, and possible challenges of a centralized policy in an inherently decentralized industry environment. Conclusions reinforce the need for local health care systems and administrators to adopt and adapt the Joint Commission’s high reliability model to their system to correct industry failures.