Surgeons well-positioned to champion high reliability

In health care, high reliability means care that is consistently safe and efficient across all services and settings. Earlier this year, Mark R. Chassin, MD, MPP, MPH, FACP, president and chief executive officer of The Joint Commission, wrote in an article in Healthcare Executive Magazine that he believes a day without patient falls, health care-associated infections, or patient safety events of any kind is not only possible, but achievable.1

In that article, Dr. Chassin stated that leadership commitment is the first and most essential step in the journey to high reliability—and that leaders must commit to the ultimate goal of zero harm.1 To begin achieving high reliability, Dr. Chassin suggested the use of Robust Process Improvement (RPI) tools—including Lean Six Sigma and change management—as well as some of the resources available from the Joint Commission Center for Transforming Healthcare, such as Oro 2.0 and Targeted Solutions Tools.1

A framework

In 2013, Dr. Chassin and the late Jerod M. Loeb, PhD, former executive vice-president of The Joint Commission’s Division of Healthcare Quality Evaluation, detailed a framework for high reliability in health care in an issue of Milbank Quarterly.2 Under this paradigm, highly reliable organizations would do the following:

  • Attain a leadership commitment to zero harm
  • Establish a safety culture in which all employees speak up to prevent harm
  • Deploy highly effective process improvement methods

Leadership in health care is undoubtedly a crucial aspect for institutions seeking to achieve high reliability—as well as striving to achieve zero patient harm. But how can health care leaders most effectively engage their surgeons, physicians, nurses, and other health care staff to buy into high reliability, and how can they inspire those same surgeons to become champions of this effort?

Need for surgeon champions

William Choctaw, MD, JD, CSSBB, a physician advisor for the Center for Transforming Healthcare, addressed this topic in a blog post for High Reliability Healthcare.3

In “High reliability care requires physician champions,” Dr. Choctaw—who practiced general surgery for more than 30 years—wrote that the challenge most hospital leaders face is effectively engaging their physicians as collaborative partners.

Dr. Choctaw outlined the following four basic principles of a hospital and physician partnership:3

  • Identify physician champions—those “physician superstars” who are known medical staff leaders, who have a patient-centered value system, a progressive and passionate mind-set, and an ability to communicate strongly while also building consensus (among other traits)
  • Understand that not all physicians are alike, noting the importance of recognizing diversity, and developing targeted solutions to meet an individual’s specific needs
  • Ensure that hospitals take the first step toward engaging physicians—not the other way around
  • Provide financial support for physicians leading these quality efforts

Dr. Choctaw wrote that without effective collaboration between the physician champion and the institution, most initiatives will fail or not be fully sustainable. But through collaboration—a relationship based on respect, trust, and good communication—physician leaders can lead the way in establishing highly reliable quality and safety initiatives to improve patient care.3

“Hospital employees view physicians as natural leaders in the hospital environment,” Dr. Choctaw wrote. At Citrus Valley Health Partners, Covina, CA, where Dr. Choctaw practiced, 20 percent of the participants in the institution’s annual RPI Lean Six Sigma Green Belt training program were physicians. “It is the physician champion’s added diversity to any patient care and patient safety initiative that increases success and sustainability,” he wrote.

Surgeons can help champion the cause for high reliability because those same principles are already in the “DNA” of each surgeon. The American College of Surgeons describes several common traits or behaviors surgeons typically exhibit, including the following:4

  • Surgeons are people who find it extremely rewarding to act and then see the impact of their actions on their patients’ well-being.
  • As surgeons, we are able to test our hypotheses and see rapid, graphic results from our work.
  • You must be flexible. A surgeon’s day is seldom predictable, and surgeons must view this unpredictability as an enjoyable challenge.
  • Embrace responsibility and the opportunity to make a positive impact.

These traits or behaviors underscore why surgeons have the skill set necessary to champion high reliability programs and lead from the front.

Worth the effort

Surgeons see firsthand the patient complications that can result from preventable harm. High reliability strategies offer an approach that can lead to dramatically better outcomes for patients, improvements to systems of care, and lower costs. Ultimately, these initiatives can lead to more effective, more efficient surgical care.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


  1. Chassin MR. Zero harm: An achievable goal. Healthcare Executive Magazine. March/April 2018. Available at: Accessed August 23, 2018.
  2. Chassin MR, Loeb JM. High-reliability health care: Getting there from here. Milbank Quart. 2013;91(33):459-490.
  3. Choctaw W. High reliability care requires physician champions. High Reliability Healthcare. July 25, 2018. Available at: Accessed August 23, 2018.
  4. Johansen K, Heimbach D. So you want to be a surgeon. Section 1: Surgical traits. Available at: org/education/resources/residency-search/traits. Accessed August 23, 2018.

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