Healthcare High Reliability Organizations

Become a High Reliability Healthcare Organization

What does being a high reliability organization (HRO) mean? How can we apply high reliability concepts to healthcare organizations?

Over the course of the last several years two questions have been asked of countless leaders throughout healthcare. The answers to those questions are not quite as uniform as you would expect, and they shouldn’t be. The most communal answer to the first question would be that organizations who strive to become high reliability organizations aim to reduce patient harm over long periods of time. There definitely is more uniformity and consensus framed around that first question. The second question is where we undoubtedly see an area of opportunity through the application of a design thinking approach.

How can we apply high reliability concepts to healthcare organizations?

After working with more than 80 hospitals in Illinois on embedding high reliability concepts into organizations, we’ve learned a few things. As Thomas Edison said, “I have not failed. I’ve just found 10,000 ways that won’t work.” Our high touch engagement with those hospitals over the course of a few years demonstrated a handful of truths:

1. Webinars don't lead to behavior change.

Death by PowerPoint and webinars, or even on-demand learning, are real things. As adults we should, and do learn differently than we did in our school days. The prospect of your team members dedicating hours of time to webinars and didactic content and expecting that to translate into behavior change is low. Given this, our approach to integrating the principles of high reliability into an organization or a department is to do so in a practical, experiential way. We don’t implore teams to “competency up”, take a course or get a certification before they move to action on the high reliability front. We bake the high reliability lenses into our design thinking canvases and all your teams have to do is simply show up and candidly apply their knowledge of your systems. This enables us to assess areas of opportunity more robustly and efficiently which translates into meaningful sustained action over time.

2. This is a cultural mindset shift, not another project.

If your HRO journey is viewed by your team as another project or flavor of the month then we are doomed from Jump Street. It is critical that your approach to high reliability be one of a cultural mindset shift. The way you approach projects, teams and patient harm will now be through the lenses of the high reliability principles. By using design thinking tools we can engineer those high reliability lenses into the framework of how your teams approach processes, projects and people. If your team is not purposeful about approaching work differently and giving everyone a voice in the process, then your HRO journey will just be another fad in the view of your broader team.

3. Not top down. Bottom up and all around.

High reliability is not a directive that should be molded by the senior leadership team alone and then passed down the food chain. If this approach is taken then you run the risk of alienating the best asset you have, and that asset is the institutional knowledge of your entire team. One of the high reliability principles which resonates the most with teams is the principle of deference to expertise. If you don’t embrace this principle out of the gate then you won’t ensure that you have the buy-in or knowledge needed to sustain a high reliability culture across an organization.

4. The 5 principles of HRO are key, but don't get stuck in the ivory tower.

There are many groups who have worked to translate the HRO concepts into a curriculum which can be adopted by health care organizations. A typical approach goes something along the lines of implementing an organizational assessment from a high reliability perspective, reaching consensus on opportunities for improvement, training your staff on HRO competencies and then move to action. That high level four step methodology is not totally fraught, but the most common failure point in that process is the inability to translate that competency into action. Folks on the front line don’t resonate with terms like commitment to resilience or sensitivity to operations. Our design thinking approach to these principles takes this into account and ensures folks who are engaging with our tools don’t feel like they need a certification in HRO to get the ball rolling. Bottom line, HRO can be a dense academic topic that is hard for organizations to wrap their heads around if not delivered practically and pragmatically. Our approach offers a straightforward path to onboarding high reliability principles and integrating them into the culture of your organization.

5. De-Silo Communication > Empowerment > Accountability

When high reliability is operationalized the right way it becomes a field unifier for your organization. By taking the five principles of HROs and marrying them with our design thinking approach we have witnessed a cascade effect within organizations. Simply put, when we start to de-silo communications between individuals and departments we start to empower all members of the team and that leads to accountability. Our high reliability approach will activate your staff and enable them to apply high reliability thinking and problem solving. Our aim is to equip your team with a new way of diagnosing and solving problems through design thinking techniques framed in the lens of high reliability.

How do we achieve this?

Do Tank’s HRO Canvas is an introductory high reliability assessment tool for organizations. In just 90 minutes, the Do Tank team can work with senior leaders, departments or project teams to diagnose their current state and begin to think of how that current state could be improved if we applied the principles of high reliability. 

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