What comes to mind when you think of Highly Reliable Organizations (HROs)? NASA? Airlines? Nuclear Plants? The fact is, an HRO is more than just a buzzword. HROs are industries that function safely despite being in a high-risk field or having highly complex processes. The Agency for Healthcare Research and Quality (AHRQ) describes HROs as organizations that, even though they have highly hazardous and complex processes, can function with limited serious or catastrophic incidents. They can do this because they have built processes and procedures that help ensure safety and performance, which are at the forefront of everything they do. A fundamental part of being a Highly Reliable Organization is having situational awareness and mindfulness – a key example is preventing medication errors – by following appropriate processes that can help circumvent errors that make headlines.
For years, I have heard the comparison that healthcare should have the same reliability as the airline industry. On my most recent flight, the weather was not the greatest, but as I sat at the gate, I watched out the window as the pilot, in a labeled vest, did his part and made the personal checks to our aircraft. I was immediately at ease. While there are never guarantees, I felt safer knowing he did those safety checks. He ensured my safety and was proactive by following the safety systems put in place to identify issues before an incident occurred. Suppose you were a patient in a healthcare setting – wouldn’t you like to know that the facility implemented processes and procedures to help ensure safe and effective care and were followed consistently? Or know there are checks and balances for error prevention? We know there is always a chance of error, but operating as a Highly Reliable Organization dramatically reduces the likelihood of a catastrophic event or poor outcome.
When we are proactive, we are mindfully planning; we are demonstrating a preoccupation with failure and building processes to ensure a culture of safety. On the other hand, when we are reactive, we are responding to events as they occur. The system waits for problems before addressing system gaps and failed processes. When we seek to be consistently great, we strive to have the best and safest processes in place, thus strengthening the case for taking the steps and working to become a Highly Reliable Organization. When starting the path to becoming a Highly Reliable Organization, the Agency for Healthcare Research and Quality (AHRQ) states there are five qualities to consider:
- Have a Preoccupation with Failure. Mindfully anticipate mistakes and do the leg work to investigate systems for fallibility. Work to standardize workflows and build resiliency to bounce back and recover from mistakes and errors.
- Be Reluctant to Simplify. Workers must know the why behind processes and procedures. Having this understanding helps reduce the chance of shortcuts and workarounds, thus helping to prevent mistakes and errors. Reluctance to simplify also means having consistent communication among staff, follow-through of issues, accountability, and utilization of interdisciplinary teams for problem-solving.
- Be Sensitive to Operations. These organizations also have situational awareness, where team members understand what processes are working and what isn’t and how to communicate to leadership. Leadership must be willing to have an open mind and hear about potential problems. The effectiveness or ineffectiveness of processes can directly affect positive and negative outcomes. Thus making the evaluation of outcomes beneficial to determining what objectives or key performance indicators are met and what needs to be adjusted to be helpful to the organization.
- Have a Commitment to Resiliency. As stated earlier, there are no guarantees; mistakes and errors will and do happen. However, the response to those errors and mistakes drives process and system changes. Organizations can proactively build resiliency by implementing best practices, using evidence-based materials, performing risk assessments, Failure Mode and Effects Analysis (FMEA), and system evaluations.
- Defer to Expertise. Utilize those with the most knowledge of processes by involving your frontline staff in process evaluations. If you want to know first-hand the issues or what would best improve workflows, ask those directly performing the tasks daily. Organizations must have the willingness and fortitude to evaluate processes openly without intimidation to get the most valuable and honest feedback.
To summarize, committing to becoming a Highly Reliable Organization shows a dedication to improving safety and outcomes. This process is often complex and time-consuming but ultimately changes facility culture. High Reliability is mindfulness in following procedures and improving workflows to prevent errors, making facilities function safely, and having the best possible outcomes, which is every facility’s primary goal.
Inspirien’s Risk Consultants offers classes to help your organization become a Highly Reliable Organization, including Safety of Culture Principles. This class and others are included in the benefits package for Inspirien customers and HWCF members. If you are not a customer and want to know more about Inspirien’s suite of products and services, please get in touch with our Risk Consultants at riskmanagement@inspirien.net or call 1-800-821-9605 to speak to a member of our Risk team.
Article contributed by Wendy Shurette, Risk Consultant for Inspirien.