title: Memorial Hermann: high reliability from board to bedside.
abstract: BACKGROUND
  In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution.
  
  
  METHODS
  The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems.
  
  
  RESULTS
  The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero.
  
  
  CONCLUSIONS
  MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.
authors.affiliation: Memorial Hermann Health System, Houston, USA.
authors.forename: M Michael
authors.initials: MM
authors.lastname: Shabot
authors.forename: Douglas
authors.initials: D
authors.lastname: Monroe
authors.forename: Juan
authors.initials: J
authors.lastname: Inurria
authors.forename: Debbi
authors.initials: D
authors.lastname: Garbade
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: France
mesh_terms: D006739:Hospital Administration; D006788:Hospitals, Voluntary / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D015279:Organizational Culture; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D013781:Texas