Applying the Science of High Reliability to Improve Operations and Increase Organizational Resilience: Especially in Times of Disruption
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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.
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Applying the Science of High Reliability to Improve Operations and Increase Organizational Resilience: Especially in Times of Disruption
- 1. Fran Griffin, RRT, MPA October 28, 2020
- 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 3
- 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
- 5. Expected Conditions — What are the expected conditions for this schedule? — What assumptions are made? 5
- 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 6
- 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
- 9. What is the role of an expediter? 9 © Fran Griffin & Associates, LLC
- 10. 10 — What steps should be standard? — What are the expected conditions? — What assumptions are there about staff, supplies, patients, environment, etc.? — What unexpected events or conditions often occur? — How is the unexpected recognized? — What is the response to the unexpected? Assessing a Process or System © Fran Griffin & Associates, LLC
- 11. Mini-Test: Process Reliability — Ask 5 people: — How do you complete this process? — What do you do if a step fails? — If the answers are different, the process may not be reliable! 11© Fran Griffin & Associates, LLC
- 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
- 13. — Good: Signal of unexpected condition — Use for learning — Design response or redesign as expected — Reward staff who identify and adapt — Bad: Deliberate variance from standard without unexpected condition Workarounds: Good or Bad? 13© Fran Griffin & Associates, LLC *Pictures from www.baddesigns.com
- 14. 14 — Are employees and managers learning from our work every day? — Are staff encouraged to identify the need to modify a process and share for learning? — How often do staff adjust a process based on changing conditions? — How often do I ask “why” or encourage others to do so? — How do we find external ideas in my organization? — When is the last time a front-line person suggested an idea that we tried? Am I in a learning organization? © Fran Griffin & Associates, LLC
- 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
- 17. 17 My golf game… A hole in one! Balls on fairway, none lost Score same or better than before Approaching par score A few balls lost in water or woods but completed each hole © Fran Griffin & Associates, LLC
- 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
- 20. Assessing where your organization is on the journey 20© Fran Griffin & Associates, LLC
- 21. 21 — Design — Standardization, Input, Human Factors — Analysis — Failures and Successes — Data, Feedback — Redesign — Continuous, based on learning from operational adjustments — Response — Proactive vs. Reactive — Standard for recurring unexpected conditions Key Categories © Fran Griffin & Associates, LLC
- 22. © Fran Griffin & Associates, LLC 22
- 23. 23 — Take advantage of existing groundwork — Standard tools, response systems, etc. — Plan for success: Pick a topic and location with receptiveness to change and a champion 1. Design process: standardize, include front line 2. Identify the expected conditions for the standard 3. Identify the recurring unexpected conditions (including human factors) and design response(s) Getting Started © Fran Griffin & Associates, LLC
- 24. 24 — Define the expected conditions — Set standard(s) for consistency within expected conditions — Learn from variation to identify recurring unexpected conditions — Design standard response to common unexpected conditions — Support mindfulness — Identification of unexpected conditions — Real time solutions — Continuous learning and adjustment Moving to High Reliability © Fran Griffin & Associates, LLC
- 25. 25 — Recognize that you cannot change the culture BUT you can change things that will change the culture — Become a learning organization — This has no end point! — Move to reliable processes and responses first — Understand what is expected — Prepare to more pro-active, less reactive — Recognize it is a journey Starting the journey © Fran Griffin & Associates, LLC
- 26. 26 Would you like to learn more about Health Catalyst’s products and services? — Yes — No Poll Question