Resource Library-Assessing Progress on the Journey to High Reliability

Video Transcription

Video Summary

The session describes how the Veterans Health Administration (VHA) is measuring progress on its journey to higher reliability, with “zero harm” as its true north. Because harm metrics are lagging indicators, VHA developed a maturity framework to assess leading cultural and behavioral factors that enable safer care. Building on external models (Joint Commission’s ORO 2.0 and IHI’s safe/reliable care framework), VHA first conducted externally facilitated baseline assessments across 172 medical centers. It then iteratively redesigned the approach into an internal self-assessment tool meant for reflection and planning—not scoring, ranking, or comparison. The updated model keeps three pillars (leadership commitment, culture of safety, continuous process improvement) but shifts assessment toward 14 specific focus areas, supported by an assessment toolkit, analysis guide, and planning guidance. Pilot testing produced refinements, including clearer language and added emphasis on inclusivity (e.g., DEI) and non-clinical areas. The rollout follows a PDSA-like cycle: prepare, assess, analyze, and plan, emphasizing using results to identify gaps, build trust, and guide meaningful next steps.

Asset Caption

Speakers: Amjed Baghdadi, MHA, Jessica Behrhorst, MPH, CPHQ, CPHRM, CPPS,

As VHA works to continuously improve its HRO assessment process, it identified opportunities to optimize the baseline version of the VHA HRO Framework, Maturity Model, and Matrix for usability across the enterprise. This improvement cycle included a literature review and an exploration of best practices. In addition, this work sought to create alignment with other existing frameworks. A gap analysis was done to develop the next iteration of the Framework, which was piloted across various settings throughout VHA prior to broader implementation. This session will describe the development of the VHA Framework and the improvement cycle used to optimize it.

Meta Tag

Competency Tag PS2

Competency Tag Description Apply safety science principles and methods to healthcare quality and safety work, leveraging safety curriculum and competencies to promote teamwork.

Domain Tag Patient Safety

Keywords

Veterans Health Administration (VHA)

high reliability organization (HRO) maturity framework

zero harm patient safety

self-assessment tool for cultural and behavioral factors

leadership commitment culture of safety continuous process improvement

PDSA cycle prepare assess analyze plan