Creating a Culture of High Reliability

The MHA Keystone Center is dedicated to educating and improving workplace culture in member hospitals. We encourage hospitals to adopt a strong cultural stance on patient safety by emphasizing the importance of improvement at the organizational and unit level. This includes embracing a patient safety-oriented philosophy that is reflected throughout the mission statement, vision and organizational goals. As one of our foundational concepts, the MHA Keystone Center recognize the importance culture improvement plays in achieving safer workplace for employees, patients and better healthcare for our communities.

Learn more about the MHA Keystone Center’s culture improvement efforts below.

The MHA Keystone Center Speak-up! Award

Launched in March 2016, the MHA Keystone Center Speak-up! Award is designed to acknowledge the efforts of individuals or teams within MHA Keystone Center Patient Safety Organization (PSO) hospitals who speak-up to prevent potential harm to patients or other staff members. The award not only represents a volitional voicing of concerns by one or more people, but is a tool through which one may eliminate preventable harm caused by miscommunication and non-communication. The MHA Keystone Center Speak-up Award is an adaptation of the Minnesota Hospital Association’s Good Catch for Patient Safety Award. Learn more about the MHA Keystone Center Speak-up! Award on our awards page.

Comprehensive Unit-based Safety Program (CUSP)

The MHA Keystone Center uses the John Hopkins University/Agency for Healthcare Research and Quality’s Comprehensive Unit-based Safety Program (CUSP) to drive culture change in member hospitals. CUSP is designed to educate and improve awareness about patient safety and quality of care. This program empowers staff to take charge and improve safety in their workplace, while creating partnerships between units and hospital executives to improve organizational culture. Additionally, the CUSP framework helps units to better leverage resources for improvement efforts and provide tools to investigate and learn from defects. The unit-based safety team uses a structured process while deferring to the local wisdom and insight of front-line staff who prevent safety hazards every day (AHRQ, 2011).

Learn more about CUSP in the video below.

Member hospitals can learn more about our cultural improvement efforts and access resources on the MHA Community.

AHRQ (2011). Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections. Retrieved from

Safety, Communication, Operational Reliability and Engagement (SCORE)

Duplicative survey efforts in most hospitals continue to create cost burden, survey fatigue and isolated datasets that do not produce a comprehensive snapshot of the factors driving hospital performance. The need for survey integration has never been more acute, as has the need for a more refined and specific survey instrument that clearly links measurement to improvement.

The Safety, Communication, Operational Reliability and Engagement (SCORE) survey yields valuable information about unit culture and employee engagement in organizations, and the results can be used to drive positive change. Data from the survey is used to monitor progress for those hospitals participating in the MHA Keystone Center high reliability initiative.

SCORE survey domains that are tested include:

  • Learning Environment
  • Local Leadership
  • Burnout Climate and Resilience
  • Teamwork Climate
  • Safety Climate
  • Engagement
  • Work/Life Balance

More information on the SCORE is available for members on the MHA Community.

For more information, click the contact button below.

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Leading Michigan to Better Health

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