The Top Six: Standardized Safety Practices in U.S. Army Medical Department Treatment Facilities Worldwide

Abstract

Summary Scholars and health care industry leaders have attempted to learn from high-reliability organizations (HROs) in other high-risk industries in the hopes of creating a safer environment for patients and staff. This article describes the implementation of and analyzes the outcomes of the U.S. Army Medical Department’s systemwide rollout of the Top Six HRO Communication Practices. The practices include: (1) Leader Daily Safety Briefings; (2) Safety Leadership Rounds; (3) Unit-Based Huddles; (4) Situation Background Assessment Recommendation Tool for Communicating Critical Information; (5) Institution of Briefs and Debriefs for Surgical Cases; and (6) Use of the Universal Protocol, a routinized mandatory final verification before every procedure. Over 18 months, through March 2021, each of the six components saw improvement.