Transforming a cancer center into a high reliability organization.

Abstract

234 Background: The goals of a high reliability organization (HRO) are to eliminate preventable harm and streamline processes to maximize efficiency. The NYU Langone Medical Center embarked upon transforming the entire organization into an HRO. Educating the staff of the NYU Perlmutter Clinical Cancer Center (NYUPCCC) about the principles of HRO and a stepwise rollout began in March 2018. Methods: All cancer center employees were provided with an anonymous survey designed to assess culture, teamwork and burnout. Response rate to the survey was 83%. The survey evaluated 8 areas: improvement readiness, local leadership, teamwork climate, safety climate, decision making, burnout climate, personal burnout and emotional recovery. Three areas of opportunity were identified: teamwork and communication, discussing and correcting errors and participation in decision-making. Implementation and onboarding of the NYUPCCC occurred in 3 phases due to the physical layout of the center. Infusion floors were paired with physician floors that utilized them. Three “aims” for each floor were proposed with one aim being an overlapping aim that would require collaboration between the treatment and physician floors. Weekly “huddles” at a white board occur at a defined time and is led by a different staff member each week. This 15-minute gathering of all floor staff allows for an open exchange of ideas, verbalization of new areas of improvement and staff acknowledgement who provided a service above and beyond expectations. Initiatives and results will be presented. Results: This initiative had a positive impact on culture, improved staff-wide communication, improved physician efficacy and decreased patient wait times through the utilization of staff generated ideas and processes. It identified the need for better physician engagement. It also identified a data collection challenge so that information could be gathered in real time and metrics analyzed promptly. Conclusions: Transforming the NYUPCCC into an HRO identified opportunities for staff to encourage a culture of acceptance, foster teamwork, enhance overall cancer center communication and streamline processes to maximize patient safety and overall system efficiency.