All ETDs from UAB

Advisory Committee Chair

Donna J Slovensky

Advisory Committee Members

Robert Weech-Maldonado

Patricia Patrician

Paul J Sharek

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Background: Despite significant effort, focus, and resources dedicated to reducing patient safety risk, the healthcare system continues to have high error rates. Approaches and strategies implemented to decrease human error have been marginally successful in achieving sustainable reduction in patient harm. Purpose: The purpose of this study was to examine the association between high reliability and patient safety outcomes by testing the following hypotheses: Organizations exhibiting more advanced high reliability practice will have fewer hospital acquired conditions (as defined by the Serious Harm Event Index (SHE) than organizations exhibiting less advanced high reliability practices; and organizations exhibiting more advanced high reliability practices will have fewer serious safety events (as defined by the Serious Safety Event Rate (SSE)) than organizations exhibiting less advanced high reliability practices. Methods: High reliability practice data, as measured by the Chassin and Loeb (2013) framework, was obtained from 49 organizations participating in the Children’s Hospital Solutions for Patient Safety collaborative. Ordinal logistic regression was utilized to test the association between high reliability practice scores and the SHE Index in 33 organizations and SSE Rate in 12 organizations. Results: We were unable to demonstrate a significant relationship between overall high reliability practice as measured by the Chassin and Loeb (2013) framework and SHE Index or SSE Rate. The culture of safety component of high reliability practice was significantly and negatively associated to both SHE Index and SSEs. The leadership and robust process improvement components of high reliability practice were not associated with SHE Index or SSE Rate. Conclusion: This study expands on findings from previous studies, which have shown an association between culture of safety and individual HACs and SSER. Safety culture scores were inversely associated with decreased patient harms, specifically hospital acquired conditions and serious safety events in this study. Organizational leadership and patient safety professionals can use the results of this study to inform and engage organizational leadership and the healthcare team on the application of high reliability principles to improve safety culture as an effective strategy to help eliminate preventable harm to patients.



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