Main Points:
- HROs prioritize minimizing errors and harm through a safety culture.
- HRO tools address traits like preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise.
- Tools include safety reporting systems, root cause analysis, diverse team formation, daily safety huddles, and crisis management training.
- Top HRO frameworks like The Joint Commission’s HRHCM and IHI’s Framework for Safe, Reliable, and Effective Care guide organizational transformation.
High Reliability Organizations (HROs) in healthcare focus on minimizing errors and harm through a culture of safety, continuous learning, and adaptation. HRO tools and strategies are designed to enhance these aspects, directly impacting patient safety and organizational resilience.
In this blog, we’ll share various HRO tools and strategies, categorized by each of the 5 tenets of HROs. Each of these HRO principles can be implemented in healthcare settings to foster a high-reliability culture. Continue reading to learn more about implementing HRO safety tools in the hospital setting.
Preoccupation with Failure
Preoccupation with failure in healthcare refers to the need for continuous attention to anomalies that could be symptoms of larger problems in a system. Rather than ignoring small failures or sweeping them under the rug, HROs seek to use them to detect trends or larger failures in a system.
By focusing on smaller, day-to-day mistakes, the organization can prevent large, potentially detrimental ones from occurring. Culturally, HROs find opportunities to celebrate noticing and reporting issues or near misses so that no team member fears punitive action for pursuing positive change.
HRO tools for Addressing the HRO Trait Preoccupation with Failure:
- Safety Reporting Systems: Platforms for reporting errors, near misses, and unsafe conditions anonymously.
- Root Cause Analysis (RCA): A systematic process for identifying the underlying causes of incidents to prevent future occurrences.
- Failure Mode and Effects Analysis (FMEA): A proactive tool to predict and prevent potential failures before they occur.
- Good Catch Programs: Recognizing and rewarding staff for reporting close calls and near misses, encouraging a proactive approach to identifying potential errors.
- Proactive Risk Assessment: Regularly conducting proactive assessments to identify potential risks before they lead to errors or adverse events.
- Safety Culture Surveys: Utilizing surveys to assess the safety culture within the organization and identify areas for improvement.
Reluctance to Simplify Interpretations
According to the AHRQ, people in HROs understand that the work is complex and dynamic, thus they seek underlying rather than surface explanations.
It is not enough to notice that a process or change is a success or a failure. Individuals at HROs also must understand why they achieved a given result. This deep, complex understanding can help them make the correct adjustments or replicate their success. This requires a commitment to including diverse perspectives across teams, including cross-disciplinary cooperation.
HRO tools for Addressing the HRO Trait Reluctance to Simplify Interpretations
- Diverse Team Formation: Including professionals from various backgrounds and disciplines in teams to ensure multiple perspectives are considered in problem-solving.
- Scenario-based Planning: Engaging in scenario planning to consider a wide range of potential issues and outcomes, avoiding oversimplification.
- Complexity Science: Understanding that healthcare systems are complex and adaptive, requiring nuanced solutions rather than oversimplified fixes.
- Cross-disciplinary Training: Encouraging learning across different specialties to appreciate diverse perspectives and complexities in patient care.
Sensitivity to Operations
Sensitivity to Operations means that every member of a healthcare team has the same access to information about the organization as a whole. That means administrators do not have more insight or information than frontline staff like nurses or techs. When every team member is aware of a healthcare organization’s broader goals, they can actively work toward continuous improvement.
It’s important for HROs to provide opportunities to ensure every voice is heard and respected. Every team member must believe that their insight is valuable and has the power to foster systemic change. Likewise, all members of a team must recognize the complexity of a healthcare operation and dedicate themselves to constant vigilance. The biggest key to success is open and equitable two-way communication.
HRO tools for Addressing the HRO Trait Sensitivity to Operations
- Daily Safety Huddles: Regular briefings for staff to discuss safety concerns and updates, and coordinate care effectively.
- Frontline Leadership Walk Rounds: Leaders regularly walk around clinical areas to engage with staff, understand ongoing operations, and identify safety concerns directly from frontline workers.
- Real-time Dashboards: Use of technology to monitor and display key performance and safety indicators in real-time.
- Simulation Training: Hands-on training scenarios that mimic real-life situations to prepare staff for a variety of operational challenges.
- Operational Debriefs: Implementing routine operational debriefs following shifts or significant incidents to discuss what went well, what didn’t, and why.
- Capacity Management Tools: Utilizing tools to monitor patient flow and staff workload in real-time to manage operational capacity effectively and prevent overburdening resources.
Commitment to Resilience
The reality of working in a hospital or healthcare setting is that things not only can go wrong, but they will go wrong. When you are working with sick, aging, medicated populations, understaffed teams, and high-stakes scenarios, adverse events and human error are commonplace. A commitment to resilience is a commitment to respond to incidents effectively and immediately, reducing harm and moving forward with new tools and insights.
Resilient teams are prepared and use negative experiences to inform organization-wide decision-making for the future. Furthermore, resilient HROs provide their teams with the resources necessary to process and move on from traumatic or stressful experiences in the workplace.
HRO tools for Addressing the HRO Trait Commitment to Resilience
- Crisis Management Training: Preparing staff to respond effectively to emergencies and unexpected situations.
- Resilience Engineering: Developing systems and processes designed to adapt to and recover from failures or challenges.
- Staff Support Programs: Providing resources for mental health, stress management, and recovery from traumatic events to maintain a resilient workforce.
Deference to Expertise
An administrator in an office may have a great deal of education and experience and, on paper, may be able to demonstrate superlative levels of healthcare expertise. Still, that administrator does not and cannot understand the complexities of working in frontline, patient-facing roles at the point of care. HRO leaders comprehend that healthcare is dynamic and ever-changing and that the experts are those living and engaging with organizational processes every day.
In other words, deference to expertise is the cultural understanding that the most senior member of a team may not be the best equipped to handle an emergency or even to speak cogently on an issue. At times, even outside contractors might be a better fit for a role, such as survey data collection or data abstraction.
When creating an HRO in healthcare settings, the willingness to grow and pursue new expertise should be rewarded at all levels of an organization. Additionally, all staff members have the freedom and ability to speak up about potential issues or hazards without fear of retribution.
HRO tools for Addressing the HRO Trait Deference to Expertise
- Multidisciplinary Rounds: Involving experts from various disciplines in patient care planning and decision-making.
- Expertise Directory: A resource listing the specific skills and knowledge of staff members, accessible for consultation when needed.
- Integrating External Expertise: Forge strategic partnerships with organizations like
- Peer Review Committees: Groups of professionals reviewing and learning from each other’s work to improve quality and safety.
- External Expertise: American Data Network (ADN) to bring external expertise into the hospital’s quality team staffing matrix. This approach enriches the team with specialized knowledge in patient safety, data analytics, and quality improvement that might not be available in-house. Grab 20 minutes on our team calendar as an easy way to explore this tactic as a way to elevate your team’s impact.
Top 2 HRO Frameworks
An HRO framework provides a structure as a healthcare organization works to implement the above HRO principles into their organization. The right implementation strategy can reduce the time and resources used in the pursuit of HRO status.
An article published in the September 2020 issue of the Journal of Patient Safety, “Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review,” sought to synthesize all the HRO frameworks, metrics, and implementation effects to help inform health systems’ efforts toward becoming HROs. The authors reviewed bibliographic databases from 2010 to 2019, identifying 23 key articles detailing 8 different frameworks.
Of the 8 frameworks analyzed, 2 stood out because they “involved extensive stakeholder involvement in their development and were the most comprehensive, broadly applicable, and sufficiently detailed to inform implementation.”
Each framework incorporates high-reliability tools and tactics that a crucial for success. We’ve provided an overview of these exemplary HRO frameworks below.
The Joint Commission’s High-Reliability Health Care Maturity Model (HRHCM)
Based on its extensive healthcare experience and through studying the features of industries that have achieved high reliability, The Joint Commission® constructed a framework that healthcare organizations can use to accelerate their progress toward the ultimate goal of zero harm.
The framework is organized around three major domains of change:
- Leadership committed to the goal of zero harm
- An organizational safety culture where all staff can speak up about things that would negatively impact the organization
- An empowered workforce that employs Robust Process Improvement (RPI) tools to address the improvement opportunities they find and drive significant and lasting change
Institute for Healthcare Improvement’s Framework for Safe, Reliable, and Effective Care
A group of subject-matter experts at IHI and Safe & Reliable Healthcare (SRH) have collaborated for over 15 years to develop the Framework for Safe, Reliable, and Effective Care. Made up of two foundational domains — culture and the learning system — along with nine interrelated components, with patients and families at the core, the framework brings together succinctly and in one place all the strategic, clinical, and operational concepts that are critical to achieving safe, reliable, and effective care.
Interested in beginning your organization’s HRO journey? Begin with our Ultimate Guide to Becoming a High-Reliability Organization + Free Tools to Help Build Your HRO and Measure Progress.
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