Principles of high reliability have been a strategic focus for many hospitals and healthcare systems. Still, significant disruptions, such as the COVID-19 pandemic, often push strategic initiatives aside or categorize them as “not important right now.” However, high-reliability organizations (HROs) principles and practices are essential in uncertain times to support operations and organizational resilience.
Fran Griffin, an independent consultant with over 25 years of experience in healthcare—specializing in the areas of patient safety, quality improvement, and high reliability—discusses the characteristics of HROs and how to apply these principles in both expected and unexpected situations. Fran discusses approaches to process design and analysis, movement from “Safety 1 to Safety 2,” and the impact on organizational culture. She also shares strategies for self-assessing an organization’s progress on the high-reliability journey.
After this webinar, attendees will be able to:
-Describe how high-reliability practices support operations in both expected and unexpected situations.
-Summarize key concepts from Safety 2 approaches.
-Apply self-assessment methods to their organization.
-Identify opportunities for design and redesign using HRO principles.
Similar to Applying the Science of High Reliability to Improve Operations and Increase Organizational Resilience:Especially in Times of Disruption (20)
2. 2
Following this session, participants will be able to:
• Describe how high reliability practices support operations during both
expected and unexpected conditions
• Summarize key concepts from Safety 2 approaches
• Apply self-assessment methods to their own organization
• Identify opportunities for design and redesign using HRO principles
Objectives
3. Characteristics of HROs
— Pre-occupation with failure
— Reluctance to simplify interpretations
— Sensitivity to operations
— Commitment to resilience
— Deference to expertise
*From “Managing the Unexpected” by Weick & Sutcliffe
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4. 4
— …rarely fail even though they encounter numerous unexpected
events
— …face an “excess” of unexpected events because
— technologies are complex
— constituencies vary in demand
— people who run the systems have incomplete understanding
*From “Managing the Unexpected” by Weick & Sutcliffe
High Reliability Organizations
6. The Unexpected
— A person or unit has an intention,
takes action, misunderstands the
world.
— Actual events fail to coincide with the
intended sequence.
*From “Managing the Unexpected” by Weick
& Sutcliffe
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7. What is unexpected?
— What conditions or events are
unexpected in the design of this
schedule?
— How does an airline identify and
respond to these unexpected
situations?
7
8. Managers in an HRO
…take pride in the fact that they spend their time putting
out fires…as evidence that they are resilient and able to
contain the unexpected
*From “Managing the Unexpected” by Weick & Sutcliffe
8
12. Healthcare processes
Towards Reliability
•No individual
autonomy to
change process
•Process owned
from start to finish
• Learn from defects
before harm occurs
•Constantly
improved by
collective wisdom
•Variation based on
clinical criteria
Unreliable
•Lots of autonomy
•Not owned
•Little or no feedback
for improvement
•Constantly altered
by individual
changes
•Performance stable
at low levels
•Variable
*From Terry Borman, MD, Mayo Health System 12
15. 15
From Safety I to Safety II
Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published
simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia.
Principle Description Assumptions
Safety I As few things as possible go wrong
by eliminating causes, improving
barriers or both.
Things go wrong due to
identifiable failure(s) of
component(s).
People are a risk as they are
most variable component.
Safety II As many things as possible go right
due to the system’s ability to
succeed under varying conditions
Everyday performance varies
because people are responding
and adapting to varying
conditions.
People are a resource providing
flexibility and resilience.
https://safetysynthesis.com/onewebmedia/WhitePaperFinal.pdf
16. Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published
simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia.
16
18. Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published
simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia.
18
Adverse
events
19. Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published
simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia. 19
Adverse
events
System of care