Abstract: It is well known that health-care performance is highly variable and not reliable. To address this issue, a number of health-care leaders have been experimenting with operational methods derived from non–health-care industries. Leaders at Stanford Hospital and Clinics, Stanford Children’s Hospital at Stanford, and ThedaCare have been studying and applying principles from consistently high-performing organizations such as Toyota (The Toyota Production System) and safety practices derived from aviation and other industries. They have been designing the new playbook for improving health-care reliability and performance. This article will explore 4 important constructs required to deliver high-reliability health care. These include purpose, process, people, and management system.We will also explore why improvement fails in health care, and finally, we will describe the rigorous training and constant attention to reviewing and updating standard work, which is required for success.
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