For several years, the common topic for the leadership interview on the last day of the survey was the five “pillars of leadership” as described in standards LD.03.01.01 – LD.03.06.01:

• Using data
• Planning
• Communicating
• Changing Performance
• Staffing

This topic is still often used during leadership interviews on Behavioral Health surveys. Thus, BH leaders should be prepared to discuss how they are using these functions to drive safety and quality within their organizations.

More recently, however, during surveys of psychiatric hospitals (as in surveys of all types of hospitals) the surveyors are focusing on the topic of high reliability in healthcare.  High reliability in healthcare seeks to apply lessons learned from industries such as commercial aviation and nuclear power that operate under hazardous conditions yet maintain safety levels much higher than healthcare. Proponents advocate that adapting lessons of high reliability science to healthcare offers the promise of enabling hospitals to reach levels of quality and safety comparable to those of the best high reliability organizations.

A key article on this topic is “High-Reliability Health Care: Getting There from Here” by Mark Chassin, MD, TJC President/CEO and Jerod Loeb, Ph.D., TJC Executive VP for Healthcare Quality Evaluation (2013.)  It describes the concept of high reliability and adapting this science to hospitals. The article also offers a framework for assessing your hospital’s journey toward high reliability. There is a grid on which you can rate your hospital’s stage of maturity in three critical domains:

• Leadership
• Safety Culture
• Performance Improvement

In each of these domains, the model describes characteristics of hospitals that are in the following developmental stages:

• Beginning
• Developing
• Advancing
• Approaching

Thus, if you are preparing for an upcoming TJC survey, you will want to familiarize yourself with the concept of high reliability in healthcare and share this article with your leadership team. Even if you are not preparing for survey, the concept is great food for thought for any leadership team building a culture of safety and quality within their organization. There are additional resources on this topic on the TJC website. Visit the High Reliability Resource Center to view articles, publications and videos and to learn about how other hospitals are applying high reliability within their organizations.