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The Journey to High Reliability in the NICU

Bondurant, Patricia G. DNP, RN; Nielsen-Farrell, Jill MSW, LAc; Armstrong, Lori MSN, RN, NEA-BC

The Journal of Perinatal & Neonatal Nursing: April/June 2015 - Volume 29 - Issue 2 - p 170–178
doi: 10.1097/JPN.0000000000000101
Feature Articles

Neonatal intensive care units (NICUs) are at high risk for medical errors due to the population, setting, and complexity of care. Furthermore, “near misses” often precede actual errors yet are mostly underreported and unrecognized as safety concerns. There is a growing recognition that a systems approach to quality and safety is foundational to improving care at the bedside and patient outcomes. The High Reliability Organization model is one such approach. It recognizes the challenges of a highly complex system and combines this recognition with a continual emphasis on reducing errors. Although the principles of the High Reliability Organization hold promise in accelerating quality and safety in the NICU, it is imperative that nurses at the bedside as well as nurse leaders actually learn how to operationalize high reliability principles and strategies that lead to better outcomes. This article outlines the necessary principles, culture, strategies, and behaviors that NICU nurses and nurse leaders must adopt to achieve high reliability in their units.

Department of Nursing, Texas Children's Hospital, Houston, Texas (Dr Bondurant and Ms Armstrong); and MoonPenny Consulting (Ms Nielsen-Farrell).

Correspondence: Patricia G. Bondurant, DNP, RN, Department of Nursing, Texas Children's Hospital, Houston, TX 77030 (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: December 4, 2014; accepted for publication: February 21, 2015.

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