Ready Reliable Care: The Defense Health Agency’s approach to high reliability

In its everyday actions, high reliability is the overarching framework guiding the Military Health System (MHS), comprised of the Defense Health Agency (DHA), the three Military Medical Departments and the Uniformed Services University. The High Reliability Organisation (HRO) framework, branded Ready Reliable Care (RRC) in the MHS, is based on process design, building culture and structures that promote safety, and improving outcomes to optimise HRO maturity. HROs achieve top outcomes and remain largely error free despite operating in complex or high-risk environments. Operations in HROs are characterised by repeatable processes that are regularly evaluated for change and improvement in collaboration with other affected areas of the organisation. DHA looks to other top health systems for leading HRO practices and characteristics to adapt and implement with the goal of achieving top outcomes in standardising processes; improving team communication; eliminating redundancies and gaps; and elevating the quality of care, safety and access for our beneficiaries. As part of that HRO journey, the DHA seeks to achieve system effectiveness across units through analysis, innovation and the sharing of information and knowledge. RRC provides a unified lens through which functional areas can learn from past experiences to build on and mature interoperable HRO capabilities that support service members and facilitate a consistent, safe, quality patient experience across the DHA. The DHA aims to ensure system maturity by conducting an assessment that will guide the development of capabilities needed to advance HRO principles and behaviours. In conjunction with functional subject matter experts, DHA developed an RRC Military Medical Treatment Facility (MTF) Maturity Index-Model to assess organisational HRO maturity at inpatient medical centres and community hospitals. The capability components of the RRC MTF Maturity Index-Model will align existing DHA and trusted national data sources and benchmarks to determine the current phase of RRC maturity at individual MTFs and across the system. Adaptation of this maturity index-model by other healthcare systems is possible and could provide other health systems with a tool to measure maturity of these healthcare systems as HROs.