Hospital Impact: Amid turbulent times, high reliability organizations must learn to be resilient

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The more things change, the harder it is to prioritize decisions on a day-to-day basis. As a leader in a high reliability organization, your role must evolve to meet this gap.
Darlene Cunha
Darlene Cunha

Over the past few years, healthcare organizations have joined the likes of nuclear power plants, air traffic control systems and naval aircraft carriers in the journey to become high reliability organizations (HROs).

An HRO is one that has been successful in avoiding disasters despite being in a high-risk field where accidents are expected. But how do we remain resilient and maintain the five principles of a HRO during this chaotic time in healthcare, when we are being asked to do more with less?

The five principles inherent to becoming a HRO are:

  1. Preoccupation with failure: Do not ignore any failure, no matter how small. Small deviations often times can lead to tragedy.
  2. Reluctance to simplify: Do not explain away problems. Reject simple diagnoses. Attack failures head on and conduct root cause analyses.
  3. Sensitivity to operations: The best picture of what is occurring comes from the front line. Front-line employees are closer to the work than executive leadership, and are better positioned to recognize failure and identify opportunities for improvement.
  4. Commitment to resilience: The ability to anticipate trouble and improvise when the unexpected occurs.
  5. Deference to expertise: Expertise, rather than authority, takes precedence. When conditions are high-risk and circumstances change frequently, on-the-ground subject matter experts are essential for assessment and response.

We know that system performance in healthcare hinges on the ability to match demand for care with the resources that are needed to provide it. Given the present uncertainty of the Affordable Care Act, the divestiture of hospitals across the country in order to remain solvent, along with decreased payer reimbursement, can providers continue to adopt the five principles of a HRO and maintain resilience in this high-pressure industry?

Remaining adaptable and foreseeing challenges that threaten your mission must become part of your everyday thinking in order to achieve resilient performance.

"HROs give their employees the tools they need to do their jobs, but more importantly, a voice to speak up when processes and systems go awry."

The inception of accountable care organizations invoked many academic debates, as efforts to drive reform forward resulted in false starts that stopped momentum before it could build. The idea of transformational change has existed for years now, and revolutionary change across the healthcare system is now our reality.

Traditional healthcare reimbursement models are being replaced by new payment methodologies and incentives built around the concept of value and shared risk. Responding to this momentous change is imperative for the long-term viability of all hospitals and health systems.

We now know that evolving with the ever-changing healthcare environment is imperative for the long-term viability of all hospitals and health systems. Health systems must examine their current capabilities and capacity to exist within a value-based environment, and be willing to restructure care delivery when and where necessary, and do it efficiently without compromising the HRO mindset.

RELATED: How providers, payers and pharma can work together to drive the transition to value-based care

An organization’s past success or current position in the market will not shield it from the force of reform, and with that comes inherent risk. HROs give their employees the tools they need to do their jobs, but more importantly, a voice to speak up when processes and systems go awry.

So how do the best managers continue to lead in turbulent times? They remember their fundamental purpose. The more turbulent it gets, stop, assess and reassess the situation and lead with a calm and reassuring manner. Project the organization’s mission, purpose and top goals. Use the daily morning huddle to debrief, reset and refocus before jumping back into the chaos. Eventually you will move through it.

Find opportunities to remind your team of their purpose and mission when things get chaotic. Purpose, above all else, is the source for engagement and motivation in the workplace.

During turbulent times, communication inevitably breaks down. When people stop talking and listening, all the fears and difficulties associated with change come out in force. The role of a manager during periods of change must evolve from encouraging communication to brokering communication. Do not leave effective communication to chance.

When new variables are constantly being introduced at work, setting priorities gets harder. The more things change, the harder it is to prioritize decisions on a day-to-day basis. As a leader in a HRO, your role must evolve to meet this gap.

Above all else, do not forget to listen. When things are crazy at work, your ability to listen is crucial. Even if you do not have all the answers, sometimes just allowing your team to vent, talk things through with you, helps them to see the bigger picture. The sheer act of communication through listening and understanding, can make the difference between a team that stays positive and productive and a team that becomes toxic.

RELATED: To make a difference, listen to frontline healthcare workers

As we all know, the crazier things get; the more mistakes are likely to happen. When pressure and stress are running high, say so. Being transparent with your team gives them perspective and a new appreciation for the work being done. What you don’t want is for the team to be fearful of what’s coming next. Fear brings out the worst in people.

As we move through the next decade, you can expect increasing technological advances that will change the healthcare industry drastically. Digital tablets that aid in patient engagement, radio frequency identification for tracking patients, and electronic health records that reduce medical errors while increasing quality of care are just a few. These advances have propelled the healthcare industry into a new realm of progress.

As we look to the next 10 years, the development of even more advanced technological tools will continue to shift the day-to-day responsibilities of those working in the industry. We must stay preoccupied with safety. We must continue to embrace the principles of HROs.

With the healthcare system undergoing so much change, successful organizations will be those that proactively design strategies that are facile, while cultivating a questioning attitude. It is the core attributes of HROs that organizations must possess today and well into the future, in order to flourish in this new healthcare paradigm. Ask yourself what inspires your team, then do it.

Darlene A. Cunha, MMHC, BSN, RN, ACHE is an accomplished senior healthcare executive, whose focus is leading change for clinical, quality and operational excellence.