Introduction
Healthcare is a field where a small mistake can lead to significant consequences. Patients in the care of physicians, nurses, and pharmacists entrust their health and lives to these professionals’ hands. Therefore, the responsibility of healthcare organizations is to foster a culture where mistakes are as uncommon as possible and high quality of care and patient safety are prioritized above other aspects. One idea that embodies this concept is High-Reliability Organizations (HROs). HROs are organizations that achieve high results in improving quality, safety, and efficiency in their industry (Myers & Sutcliffe, 2022). The following discussion presents the topic’s background, the main characteristics of HROs, and examples of activities taken by a healthcare organization to become an HRO. Although many organizations, such as Cleveland Clinic, take steps toward becoming HROs, the road to high reliability is long in the healthcare industry, as found in the latest research.
Topic Choice
This topic is crucial to modern healthcare because high reliability pursues goals that are focused on quality. In healthcare, quality implies the high level of services provided to patients and the lack of adverse events that put people’s health at risk. Examining the principles of HROs can help hospitals and individual practices look inward and analyze the current weaknesses of their operations (Patient Safety Network, 2019). Although HROs did not originate in healthcare, medical organizations have adapted their characteristics to fit their practice. Thus, it is necessary to review the main ideas linked to HROs and examine whether current research shows any improvement in their implementation in healthcare. Moreover, one can look at specific examples to see how HROs are being created in healthcare.
Characteristics of a High-Reliability Organization
High reliability can be achieved when an organization possesses five specific characteristics. The first one is a preoccupation with failure – the focus on mistakes and their prevention. In healthcare, medical errors are the third leading cause of death in the United States (Veazie et al., 2019). Human errors are frequent in medication administration, use of equipment, data safety, and more (Patient Safety Network, 2019). The prevalence of these accidents is substantial, and their prevention and mitigation are essential for a hospital to improve its care quality. HROs constantly think about scenarios where mistakes can occur to prevent adverse events from happening. Moreover, a lowered rate of failures or their absence is not treated as a reason for stagnation but as an opportunity for deeper investigation (Myers & Sutcliffe, 2022). As a result, an HRO thinks about the risk of failure at all times, continuously aiming to minimize mistakes and accidents.
Second, HROs are reluctant to simplify the duties, responsibilities, processes, and systems. In most HROs, the tasks are complex, involving several outcomes, interprofessional collaboration, high-risk environments, and challenging decisions (Patient Safety Network, 2019). Thus, employees and leaders must realize that the work cannot be simplified completely, and many activities and choices remain difficult. In this case, one should note that HROs are not against standardization, as it can increase efficiency (Patient Safety Network, 2019). In healthcare, each patient case is treated with a degree of standardization – physical assessment usually follows procedure, and patient information is entered into the system using standardized language. Nevertheless, similar to other HROs, hospitals cannot standardize every action a healthcare professional makes because human health requires an individual approach. For example, people can have unusual symptoms, unknown allergic reactions, socioeconomic factors, and other unique traits that need a personalized approach to their issues.
The third principle is sensitivity to operations, which implies a level of awareness about the organizational context. As HROs are complex organizations, their structure may be obscure, creating difficulties in understanding the current situation (Patient Safety Network, 2019). Here, leaders should collaborate with workers to stay aware of what is happening in the organization. In healthcare, nurses and physicians are among the frontline employees who perceive all events firsthand and see the changes in patients’ health. By communicating with frontline workers, leaders of an HRO can create a foundation for a bigger picture that puts the perceived trends into the organizational structure. In this case, feedback channels are the primary tool for being informed on what is happening inside and outside the organization. Using data to update aims and processes, HROs show high sensitivity to internal operations.
Next, deference to expertise is the fourth principle that is strongly connected to the previous one. In healthcare, nurses, physicians, and other care providers complete the majority of procedures and assessments, being key team members delivering care (Patient Safety Network, 2019). While being frontline workers, they are also experts in their respective fields. It is the goal of HRO to inspire employees to continue their education and consistently improve their skills while using the acquired knowledge to better the organization (Patient Safety Network, 2019). Leaders of healthcare HROs recognize that care quality depends on the performance of its care providers. Thus, they should encourage training while also acknowledging experts’ existing skills. In these organizations, expertise becomes more valued than authority because experts can quickly assess the situation and provide solutions to arising problems based on their in-depth knowledge of the field.
Finally, the fifth principle is a commitment to resilience based on the idea that system failures cannot always be predicted. Although HROs strive to eliminate errors, they acknowledge that some events are unpredictable (Patient Safety Network, 2019). Thus, it is crucial to be vigilant and practice solving different scenarios. For example, a hospital may regularly assess its ability to respond to pandemics, natural disasters, accidents, and other small and large issues that need rapid analysis and response. This principle requires HRO employees to collaborate and review the internal processes to identify weaknesses and threats to the organization’s resilience. Such attention to potential issues is necessary to prevent failures quickly or mitigate their adverse impact.
Chosen Organization: Description
The selected organization is Cleveland Clinic, which has been on the path to becoming an HRO for several years. The clinic has outlined new goals at the beginning of its transformation, focusing on quality. In particular, Cleveland Clinic aims to prioritize patients, including care and safety (Cheney, 2019). Furthermore, the clinic wants to improve working conditions for its employees, reduce the cost of care, and grow its impact on the healthcare industry and research (Cheney, 2019). The new goals have inspired the clinic to look at its internal processes and analyze the behaviors of its leaders, the inclusion of patients in the care process, and other factors that impact patient care quality. Currently, the clinic continues trying new approaches to improving quality and safety, and it has reached some of its milestones using the HRO approach.
Chosen Organization: Examples
One of the measurable objectives of Cleveland Clinic was to reduce the rates of patient readmissions. To achieve this, the clinic has implemented several strategies and changes to culture, which have reduced the readmission rate from 14 to 12.65% (Cheney, 2019). The organization has introduced a zero-tolerance policy for patient harm, including significant safety events and hospital-acquired infections (Cheney, 2019). This action aligns with the first principle of an HRO – preoccupation with failure. The clinic has encouraged every employee to contribute to positive changes by taking a zero-tolerance approach.
Second, Cleveland Clinic reviewed its standardized decisions and changed its decision-making strategy, introducing a team-based model. Now, instead of the prevailing authority of physicians, interprofessional teams are responsible for holding discussions and making decisions about patient treatment (Cheney, 2019). Here, the clinic has demonstrated such principles as sensitivity to operations and deference to expertise. The management has realized that nurses and other professionals possess great knowledge of patients’ well-being, acknowledging their contribution to the healing process. As an outcome, the clinic has created a new strategy that better corresponds with patient needs and improves outcomes. Furthermore, the clinic has introduced a reporting system and huddles to allow all workers to provide feedback (Cheney, 2019). This initiative supports the above-mentioned principles and helps all team members impact care quality at Cleveland Clinic.
The Most Valuable Practice
The most valuable practice that Cleveland Clinic has adopted is the organization’s reporting system. The system operates in the form of tiered huddles, where the conclusions of each meeting are reported to the higher tier (Cheney, 2019). For example, nurses in one unit may highlight an issue or an opportunity for change in their huddles. Then, the information from this meeting is given to the clinic’s leadership, where the president and chief officers discuss it and make changes to the internal processes, if necessary. Following their decisions, health system leaders may also be contacted to see whether major alterations to the system are required.
The inclusion of this practice elevates Cleveland Clinic’s performance and creates transparent expertise-based feedback channels. Nurses – frontline workers with great practical knowledge and experience – provide their insight in a comfortable atmosphere of their co-workers, which fosters an open discussion. At the same time, organizational leaders get access to this information in a structured way, where the main concerns are outlined. This allows all professionals to participate in the change process while maintaining a comfortable environment for employees.
Lessons Learned from Research
Researching the topic of HROs and the example of Cleveland Clinic adds to the discussion of quality and patient safety – two of the most important topics in modern healthcare. HRO characteristics present a well-defined list of behaviors companies can adopt to improve their outcomes. It is also clear that the concept of HROs can be implemented in healthcare, as hospitals and similar organizations easily fit the description of an HRO. The processes of any medical organization are complex, and the outcomes of each decision can significantly impact people’s health. Therefore, hospitals and other healthcare facilities should follow the example of Cleveland Clinic and analyze their current structure.
Conclusion
High Reliability Organizations exist in industries where workers operate in highly complex systems, and their choices and activities have significant, visible, and often immediate consequences. The characteristics of HROs are preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise. In healthcare, HROs aim to improve patient safety and care quality. Cleveland Clinic’s goal of reducing readmissions is a part of its initiative to become an HRO. The clinic has implemented a variety of practices and has reached a reduction in readmission rates, but it can improve further.
References
Cheney, C. (2019). Health systems and hospitals in pursuit of high reliability. HealthLeaders Media. Web.
Myers, C. G., & Sutcliffe, K. M. (2022). High reliability organising in healthcare: Still a long way left to go. BMJ Quality & Safety. Web.
Patient Safety Network. (2019). High reliability. Agency for Healthcare Research and Quality. Web.
Veazie, S., Peterson, K., & Bourne, D. (2019). Evidence brief: Implementation of high reliability organization principles. Europe PMC. Web.