AFMS follows aviation lead to high reliability Published April 6, 2015 By Air Force Surgeon General Public Affairs FALLS CHURCH, Va. (AFNS) -- Over many years, the Air Force aviation community's concept of high reliability has evolved from one of expected losses to today's culture of safety, where fatal losses rarely occur. Now, following in the footsteps of aviators and nuclear engineers, the Air Force Medical Service is adopting the principles of high reliability with the goal of eliminating errors that lead to patient harm. Lt. Gen. (Dr.) Tom Travis, the Air Force Surgeon General and a career Air Force pilot, sees strong parallels between aviation safety and patient safety in delivery of health care. "When I was a very young fighter pilot, before I went to medical school, I lost several friends in half a dozen years to aircraft accidents," Travis recalls. "In high-risk situations, we expected to have some losses in those days. And, unfortunately, we did. It is a different time for military aviation, and we have moved past the time when we thought the cost of readiness was to lose aircraft and aircrew every year. In fact, thankfully, fatal mishaps in our Air Force are pretty rare these days. The Air Force leadership and operators have embraced the culture of safety." While the AFMS has been found to provide good quality care that is safe and timely, as reported in last year's Military Health System Review, it can further reduce the chances of an error doing harm to a patient, according to Travis. "For example, we have identified some areas where key processes vary between military treatment facilities, which creates unnecessary risks," he said during a leadership summit in February. With the goal to provide the safest and highest quality of care, AFMS leaders and industry experts are collaborating to design a patient-centered, consistent system that reduces variance in military treatment facilities, standardizes processes and builds a problem-solving culture focused on patient safety. "I am so excited about the journey that the Air Force Medical Service, along with the rest of the Military Health System, is undertaking to attain the status of a highly reliable organization (HRO)," Travis said. "By dedicating ourselves as Air Force medical leaders to this change, embracing the culture of safety, and making continuous process improvement part of our daily routine, we can attain HRO status." Travis believes the AFMS has an advantage in considering how to make the changes necessary to achieve high reliability across the enterprise. "We are part of a larger organization that is founded on airpower," he said. "And aviation is one of the cultures we are now privileged to emulate to become a highly reliable health care organization." To that end, Travis has set two priorities for the AFMS: concentrate on avoiding failures that cause patient harm and create a transparent environment where everyone, regardless of rank or experience, has the responsibility to speak up and report any unsafe condition or error, with the intent to make improvements and raise awareness across the enterprise. Several other initiatives are taking shape to move forward on building the highly reliable organization envisioned by Travis and AFMS leaders. During a planning summit in March, senior leaders drafted guiding principles and tenets. Participants agreed that the guiding principles will be paramount to guide leadership and staff in building a culture of safety, which will be sustained by ongoing measurement of performance that encourages continuous process improvement. Col. John Andrus, the 59th Medical Operations Group commander, and 59th MOG Airmen at Joint Base San Antonio-Lackland, Texas, know that patient safety and quality care are the foundation for better health and improved performance. "Leadership alone cannot eliminate patient harm events, so we're taking a simultaneous 'top-down' and 'bottom-up' approach to improve both patient safety and the quality of care," Andrus said. The 59th MOG leadership and staff have implemented a culture focused on safety and quality, constant measurement of the care they provide, combined with robust process improvement at all levels. "We are developing a highly reliable system, not a program -- it is part of what we do every day in providing trusted care," said Maj. Gen. (Dr.) Mark Ediger, the deputy Surgeon General, during the summit in March with AFMS leaders. "This fits our culture, must be sustainable and enduring, and is worthy of our pursuit."