The aviation industry, nuclear power plants, NASA and emergency medical services all share a crucial characteristic: They all strive to be High Reliability Organizations (HROs). HROs are typically found in industries where failure could have serious consequences. Becoming an HRO signifies an organization’s dedication to unmatched safety standards, open communication, continuous improvement and consistent accountability.
Harris Health is well on its way to becoming an HRO. The system recently achieved a significant milestone when its hospitals, Ben Taub and Lyndon B. Johnson, earned a "B" grade from The Leapfrog Group, a nonprofit organization based in Washington D.C. that evaluates hospital safety performance. The score reflects substantial improvements in patient safety and quality metrics at the safety-net healthcare system that serves Houston and Harris County's most vulnerable populations.
Harris Health Makes Major Strides in Patient Safety, Earns Highest Leapfrog Grade Yet
By Ryann Swift on DECEMBER 23, 2024
SPONSORED BY Harris Health
“We are pleased to receive this acknowledgment of the quality work being done by both of our flagship hospitals,” says Esmaeil Porsa, MD, president and CEO, Harris Health. “Patient safety is at the core of everything we do, and this grade reflects the hard work and commitment of our medical staff, nurses and support teams. We will continue to innovate and improve to ensure the highest standard of care for our patients.”
Leapfrog administers grades twice annually. Ben Taub and LBJ hospitals earning “B” grades for the fall 2024 period comes on the heels of LBJ earning a “B” grade for the spring 2024 period, reflecting how far the healthcare system has come toward its goal of becoming an HRO.
Esmaeil Porsa, MD, president and CEO, Harris Health
"Patient safety is at the core of everything we do, and this grade reflects the hard work and commitment of our medical staff, nurses and support teams. We will continue to innovate and improve to ensure the highest standard of care for our patients."
High reliability organizations operate in complex, high-risk environments while maintaining exceptional safety records. Healthcare systems nationwide have begun adopting HRO principles to improve patient outcomes and reduce medical errors. After a rigorous appraisal, the Leapfrog “B” grades awarded to Harris Health are the result of intense effort on the part of the system. The improvement is particularly noteworthy given Harris Health's unique challenges as a safety-net healthcare system.
"We have some of the most diverse patients in Houston, some of the most socially vulnerable patients with serious needs," Brass notes. Harris Health not only contends with the expected safety challenges of a typical healthcare system, it also overcomes barriers in the population’s social determinants of health including issues of access, transportation, food insecurity and housing.
"When you don't have primary care follow-up, when you don't have a house to live in and when you don’t have healthy food to eat,” achieving positive care outcomes becomes exponentially more complicated, Brass says. “Imagine you're going home after a surgery, but you are homelesss – how do you manage the follow-up? How do you make sure the patient is safe?"
One key improvement has been the implementation of stricter hand hygiene protocols. Harris Health has set a target of 100% compliance for staff sanitizing their hands when entering and leaving patient rooms, a practice proven to reduce hospital-acquired infections.
Harris Health’s HRO Journey on the Right Track
Another significant change has been increased patient engagement in quality improvement efforts. Harris Health now includes patients on its quality committees, allowing them to provide direct feedback on safety practices. This approach has already yielded results. When the system was struggling with return rates for at-home colon cancer screening tests, patient feedback led to the implementation of educational videos during visits, significantly improving compliance.
However, maintaining and improving these grades presents ongoing challenges. Leapfrog evaluates hospitals on a curve, meaning institutions must not only improve their own performance but also keep pace with improvements at other hospitals nationwide. "Not only do you have to maintain a North Star on quality and safety every day, you have to make enough improvement so you're better than everyone else," Brass explains.
Steven Brass, MD, chief medical executive (CME), Harris Health
Despite being proud of its improvement, Harris Health isn't content with its current grade.
"Our goal is not to be happy with the B, but our goal is to end up with an A," Brass says. This improvement initiative has received strong support from hospital leadership, including Porsa and Andrea Caracostis, MD, MPH, chair, Harris Health Board of Trustees.
“Dr. Porsa has inspired our organization. He has encouraged me and offered us the support, the resources and the encouragement for our team to make the necessary changes to achieve our goal of becoming an HRO. Having the leadership commitment and the team's commitment to our journey toward improving our grades and scores are instrumental. Without leadership support and the collaboration of the physicians and nurses and the frontline staff, it wouldn't be possible,” Brass says.
Because of its size, impact and value to Harris County, becoming an HRO is in alignment with Harris Health’s existing mission.
"Our vision for this organization is to ensure that every patient is treated as if staff is caring for their mother, father, sister or brother," Brass says. "That is what I view as a highly reliable organization – that you feel comfortable ensuring that the best practices are put in place as if each patient is your family member."
To learn more about Harris Health, visit harrishealth.org
“B” Is Good, but Only One Step Toward an HRO
"Not only do you have to maintain a North Star on quality and safety every day, you have to make enough improvement so you're better than everyone else."
"We've seen several improvements in our quality metrics," says Steven Brass, MD, MPH, MBA, chief medical executive (CME), Harris Health. "Our serious safety events have gone down, and we've seen a reduction in hospital-acquired infections related to catheter-associated urinary tract infections and central line bloodstream infections."
Leapfrog grades more than 2,700 general acute-care hospitals across the nation and is particularly notable for its independence.
