Building a culture of safety through highly reliable care

Posted by MEDNAX on Sep 17, 2021 7:00:00 AM
5 minute read

It’s estimated that medical errors are the leading cause of patient deaths in the United States after cancer and heart disease. Mednax® is working to change that by empowering our clinicians to deliver the safest care through a series of patient safety initiatives across our national medical group. 

Healthcare Simulation Week, recognized this year from September 13-19, celebrates professionals who use simulation to improve the safety, effectiveness and efficiency of health care delivery and patient outcomes. This effort includes recognizing World Patient Safety Day, celebrated on Friday, Sept. 17 – a day that reinforces Mednax’s mission statement: to Take great care of the patient, every day and in every way.™ 

Our High Reliability Organization (HRO) Program and Simulation Program are examples of how Mednax supports building a strong culture of safety in our affiliated practices as well as for our hospital partners. 


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What does it mean to be an HRO? 

The HRO program builds on our legacy of improving quality care and outcomes for women and infants. Mednax uses HRO principles, incorporating Six Sigma, Team Stepps (Team Strategies and Tools to Enhance Performance and Patient Safety) and Crew Resource Management to help define a culture that promotes safety and reliability. 

According to Robert Ursprung, M.D., M.M.Sc., director of HRO and patient safety and leader of the HRO team for neonatology, the process usually begins with a conversation with the practice medical director to allow the HRO team to understand the unique context of the practice (i.e. how many deliveries per year, what level of care is typically provided) as well as potential opportunities for improvement. “We want teams to be excited and engaged in improving their unit, their teams, their efficiencies,” he said. “We emphasize to them that this is your project, this is your work. We are here to support you.” 

The program then begins its custom analysis, tailored to the goals of the individual neonatal intensive care unit, focusing on: 

  • Architecting and supporting a culture of safety 
  • Clinical research and education 
  • Quality improvement 
  • Empowering providers 
  • Encouraging teamwork and open communication 
  • Reliable, consistent care 
  • Patient-centered services 
  • Evidence-based clinical practices 
  • Non-punitive responses to errors 

The HRO team also works to identify a program champion, or an on-the-ground project leader. Mednax’s HRO program leads work as ‘back-end coaches’ to support his or her efforts. 

In an effort that builds on Mednax's legacy of providing highly reliable, safe and consistent care to our patients and their families, the HRO program has also begun an expansion to include labor and delivery (L&D). One recent example included a pilot program partnership with the L&D unit at Baylor Scott & White Medical Center – Lake Point in Rowlett, Texas.  

In an L&D setting, the American College of Obstetricians and Gynecologists (ACOG) recommends implementing bundles, also known as standardized protocols. In California, a study focusing on this approach showed that hospitals instituting bundles reduced maternal morbidity and mortality by 20%. Mednax’s HRO initiatives focuses on implementing bundles in three key areas:

  • Maternal hemorrhage
  • Hypertension
  • Venous thromboembolism 

According to Dr. Ursprung, the principles of how the HRO program approaches safety and reliability translate across specialties, emphasizing a collaborative work environment, ongoing quality improvement and education as well as high-quality, patient-centered care. “This is a value-add that Mednax is bringing to the table,” said Dr. Ursprung. “However, while our team gets the process started, we very much value the sweat equity and participation of our practices and their teams.” 

Read More: HRO in practice 

Improving patient outcomes through simulation-based education 

Building a successful culture of safety can also benefit from dynamic team training and education. The Mednax Simulation Program offers clinicians across the country opportunities to hone their skills and improve the care they provide to patients.  

“Through the partnership with the HRO team, we are able to identify sites through the HRO process that may also benefit from simulation services,” said Gillian Gonzaba, APRN, NNP-C, CHSE, LSSBB, and Associate Director for HRO/Patient Safety and Simulation. “We provide the opportunity for our Mednax facilities to embark on the HRO pathway and complement this with simulation to evaluate their processes and overall teamwork.  Much of what we focus on with our hospital partners is teamwork and improving communication. Simulation offers a great opportunity to evaluate that in medical emergencies.”

Through our suite of simulation services (including NICU, pediatric intensive care unit, labor & delivery and pediatrics), the program covers a broad range of in situ scenarios focusing on education, communication, patient safety and quality improvement.  

Program focus areas include:  

  • Interdisciplinary care team dynamics 
  • Patient safety strategies for effective communication 
  • Quality and safety measures specific to the practice 
  • Consultation to optimize or develop the use of a facility’s simulation center and equipment 
  • Train-the-trainer and standards implementation 
  • Feedback on team performance and potential areas for process improvement 

“It is a wonderful opportunity to assist our teams across Mednax – not only with their high reliability journey but also to partner with them to bring simulation to life in their facilities,” Gonzaba added. 

The Simulation Program has earned full accreditation status from the Society for Simulation in Healthcare in the areas of Teaching/Education and Systems Integration. 

Read More: Simulation in practice


Interested in seeing the benefits our HRO or Simulation programs can bring to your practice or facility?  

HRO: Request Information

Simulation: Download Brochure

Topics: Quality & Safety, CREQS, High Reliability Organization, Simulation, Health Observances