The Implementation of High-Reliability Organization Model for the Environmental Services Department at Santa Clara Medical Center


Eric Williams, MHSA; Kari Frank, MS; Marc Smith, MHA

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northern California

Background: Establishing a strong foundation that is supported from executive leadership down to the front lines is necessary to achieve a high-reliability organization. Once a reliable health care system is achieved, the organization will be able to quickly identify sources of problems and be able to quickly and effectively respond to unexpected events. This resiliency leads to reduction in patient harm and workplace safety events.
Methods: In 2018, Santa Clara Medical Center’s Environmental Services (EVS) underwent a process improvement journey. EVS found itself with high workplace safety accepted claims rates (ACR) and Clostridium difficile standard infection ratios (CDiff SIR) that were higher than regional standards. The EVS leadership team, consisting of directors and managers, participated in a value stream analysis in which they focused on hardwiring certain tools including leader standard work, daily management system, visual boards, and defining process metrics and outcome metrics. These efforts allowed them to increase their ratings in quality and safety by reducing CDiff SIR to meet regional benchmarks and improving their workplace safety ACR.
Results: For workplace safety, we looked at our ACR, total incidents, and supervisor first report. We compared our last quarter with our first 3 quarters of the performance year. We used this because we started to implement our tools and standard work at the beginning of the final quarter. For ACR, we went from an average of 8.98 for the first 3 quarters and dropped our ACR to 0.0 for the final quarter. For CDiff SIR, we had a SIR of 0.9 for the 2017 performance year. We were able to reduce our CDiff SIR to 0.79 for the 2018 performance year.
Discussion: The leader standard work that is developed and directly tied to leading indicators and outcome metrics helps the staff reconnect the “why” behind the work that they are responsible for. It highlights the meaning to their roles and allows them to fully understand their purpose. Our journey has consisted of implementing our strategies at the management level. As we continue our journey, the next steps will be to have our managers champion the work and create daily management systems for the front-line staff so that staff from executive leadership down to the front lines find their work to be meaningful and worthwhile.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.


2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, and CrossRef.




ISSN 1552-5775 Copyright © 2021

All Rights Reserved