By John Meiners
Chief of Mission Aligned Businesses and Healthcare Solutions
American Heart Association/American Stroke Association



The concept of high reliability organizations is becoming more and more prevalent in healthcare discussions on quality improvement and patient safety. The notion comes primarily from military, civil aviation, and aerospace industries, where closed loop solutions are used to identify emerging risks and intervene to prevent unintended consequence.

High reliability organizations have a unique characteristic in that they utilize real world data to inform training solutions for the future. For example, many people think that the flight recorder or black box on an airplane is used only in the event of an accident. However, that data is used on an ongoing basis for predicative analytics to assess where risks may be developing in the system before there is an accident.

The example that was shared with me once is that analysis from flight recorder data showed that pilots were sometimes landing in an unstable position. When they aren’t stable, they shouldn’t land – they should come around and try again. But pilots were landing anyway. Once that was noticed, they created new scenarios that pilots had to go through in the simulators for continuing training and re-certification.

This is a different way than we’ve typically thought about healthcare in the US and globally. While we have guidelines, they are not rigidly enforced, allowing for complicating factors and discretion of the healthcare provider. In professional or continuing education, we continue to reinforce the ideal scenario, rarely practicing adverse or complicated scenarios. Re-certification and re-education don’t generally address high-fidelity simulation and scenarios to practice response to difficult or adverse situation. Many times, providers are allowed to take continuing education that they want versus what they need based on the trends and data analyzed from their performance.

The key to a high reliability organization is using data to anticipate problems before they occur. The same concept can be applied to healthcare. We collect a lot of registry data but rarely is that data being correlated to how healthcare providers are being trained or what kinds of training we’re providing

The American Heart Association manages many registries and does a lot of professional education. We’re beginning now to tie the two things together in a way that will help get to zero medical errors. The current standard says reaching 85 or 90 percent compliance is worthy of recognition or certification. I believe that should and could be a higher standard. If we had more targeted training programs and better predicative analytics from existing patient data, we can ultimately get to 100 percent compliance, improving the quality of care and patient outcomes.

Shouldn’t patients feel more secure and confident about their medical care than they do about flying?

John Meiners, Chief of Mission Aligned Businesses and Healthcare Solutions for the American Heart Association, leads the development and expansion of the Association’s businesses that support its global mission to reduce mortality from cardiovascular diseases and stroke by 25 percent by 2025. 

John oversees several revenue-generating mission delivery departments at the Association, including Emergency Cardiovascular Care (ECC), Workplace Health, International Programs and Quality Systems Improvement. The Emergency Cardiovascular Care business is comprised of more than 4,000 training centers and 450,000 instructors who train 22 million people per year in more than 100 countries. Additionally, he leads the development and expansion of the American Heart Association’s international mission through groundbreaking collaborations with Fortune Global 500 companies, creating shared value for both.

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