4 Habits of Highly Reliable Health Care Organizations

Everyone in health care has two jobs: the one they were hired to do and that of making it better. Maureen Bisognano, a senior fellow at the Institute for Healthcare Improvement (IHI), made this simple yet profound statement 12 years ago at the IHI National Forum on Quality Improvement in Health Care.

Her keynote address posed a transformational challenge to the field as leaders struggled to meet rising market demands for an excellent patient experience and to make a meaningful impact on the patients they serve.

Then, as now, many health care executives struggled with how to design systems of care and processes with continuous improvement built into operations. And when these efforts didn’t deliver intended results, leaders and culture were often cited as the reasons.

Systems Need Fixing More Than People

Ensuing modifications to improvement plans usually called on leaders to set bolder goals, enable staff to do their best work and respond to employee feedback. These were not bad ideas, but they often were flawed, say three IHI leaders in a recent Harvard Business Review report.

The authors argue that care delivery systems need fixing far more than the people who work in these systems. Going forward, health care leaders must account for the strains on the workforce of poorly designed and unoptimized systems and create systems-focused improvement programs that everyone owns together.

Organizations like Jefferson Health in Pennsylvania, Prisma Health in South Carolina and the Greater Baltimore Medical Center have built dynamic operating models that support continuous learning and improvement via system redesign, the report notes. Many others have built aspects of these programs, which the authors call successful, to be operationally integrated, tech-enabled care operating systems.

So, what does it take to build dynamic operating systems to support continuous improvement?

4 Traits of Systems-Focused Improvement Organizations

1 | They recognize and celebrate staff commitment and passion.

Harness the brilliance of your team on a massive scale and celebrate them for their resilience and commitment to excellent care.

Takeaway

Look for opportunities to recognize individuals and teams for perpetuating continuous improvement. For example, Jefferson Health leaders during quarterly enterprisewide meetings celebrate individuals and teams that “make a great catch,” such as identifying a potential safety risk that leads to large-scale improvements and risk mitigation, the report states.

2 | They obsess over system improvements.

Daily workflows are the heart of these operating systems. Quality and safety team leaders concentrate day in and day out on methods to obtain feedback about how operating systems are performing.

Takeaway

This leads to daily identification, triage and resolution of real-time operational challenges. “In these organizations, the quality team is not seen as reactive, policing or scorekeeping; it is viewed as front-line clinicians’ greatest advocates,” the authors wrote.

3 | They go beyond rigorous process-improvement methodologies.

Programs like Lean Six Sigma, Total Quality Management and others aimed at creating high-reliability organizations have guided health care toward production processes proven in other fields. And yet, many health care organizations have achieved only incremental improvements using these efforts. One key reason may be that they haven’t successfully engaged workers and customers to drive daily learning and continually optimize system performance.

Takeaway

The key is for those leading efforts to improve organizational improvement to focus less on trying to get more from their workforce and more on trying to maximize what they can get from the system. This is a critical concept when considering health care’s challenge of overwhelming burnout and global shortages of physicians and nurses, the authors state.

4 | They thrive on feedback.

Successful systems-focused industries don’t regularly spend time with front-line workers discussing abstract methods, principles or theories for how they can improve their work. They devote time to seeking feedback and understanding challenges so they can design or redesign daily operations to make front-line workers’ jobs easier while simultaneously improving system output.

Takeaway

Quality and safety cannot be ancillary concerns. They must be embedded in the work itself. As health care leaders consider the path forward, they must account for the strain on their workforce and recognize that there is no greater generator of dissatisfaction than working in a system not intentionally and carefully designed for success.