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What is High-Reliability Healthcare?

How technology is critical in managing large-scale risk for High-Reliability Healthcare Organisations
hospital corridor with nurses and patients in hospital beds
| Robert Hobbs | Healthcare

The delivery of healthcare, with its huge range of assessments, procedures and interventions is inherently risky. There’s lots of room for things to go wrong and for negative outcomes such as poor user experience, harm or even death to occur, so it’s unsurprising that healthcare organisations are increasingly being recognised as “High-Reliability Organisations” (HROs) – organisations that succeed in avoiding catastrophes despite a high level of risk and complexity.

HROs work in situations that have the potential for large-scale risk and harm, but manage to balance effectiveness, efficiency and safety and minimise errors through teamwork, awareness of potential risk and constant improvement.

HROS were once the exclusive domain of nuclear power plants, air traffic control systems, and naval aircraft carriers, but healthcare organizations have now joined their ranks because even a minor error could have catastrophic consequences. As such, it’s critical for NHS Trusts to have processes in place to support the reporting of near misses and small, localised failures, as well as systems to profile risks and understand what is important and the lessons learned. Trusts also need strategies to ensure a transparent and reporting culture that helps to continually work towards improvements in delivering safe, highly reliable care whilst remaining focused on patient safety. In order to illustrate the type of culture that’s necessary to move forward toward becoming an HRO, experts point to the “cultural maturity model.”

The Cultural Maturity Model

The concept of a cultural maturity model has been around since around 1975 and since its development, it has developed and changed to help organizations think about how they can evolve from an “unmindful” risk culture to one that is “generative”:

progression of cultural change of managing risks

The tipping point is when Trusts go from a systematic model of managing risks to a proactive one in which everyone - from ward to Board – work to anticipate and prevents problems before they occur. The peak of cultural maturity is a generative culture where safety is built into the organisation’s cultural DNA and where everyone is constantly vigilant and transparent about risk and the actions to prepare, control and mitigate risk. In order to truly be a high-reliability organisation then – one that has risk properly under control – Trusts need to do all they can to move from being “systematic” to being “proactive” or “generative.” And in order to do that sustainably, easily, efficiently and effectively, Trusts need to invest in best-in-class digital risk management solutions.

Achieving High Reliability Digitally

HROs are designed to manage unexpected risk and deal with hazards and crises successfully and effectively by looking for signs of impending problems and acting quickly before things can escalate and get out of hand. In doing so, HROs are able to consistently reduce the number of accidents and failures, despite operating under complex and difficult environments. They go beyond traditional risk management practices in which internal and external risks are identified efficiently and controls are built to mitigate them.

That means that Trusts need a system that can help them not only accurately predict and mitigate risk, but also offer a way to immediately report perceived new risks as soon as they become apparent. This not only helps increase engagement and make teams feel as though they are being heard, but also improves the all-important culture of “collective mindfulness”, which is at the core of every successful HRO and in which all workers look for, and report, small problems or unsafe conditions before they pose a substantial risk to the organisation and while they are still easy to address.

Trusts that aspire to become true HROs have a culture and workforce that respond to threats dynamically, which means that they need a system that makes reporting easy, and that helps them to monitor risk in an accessible and transparent way to become “generative” in their approach.

With a modern, integrated digital solution in place, Trusts will not only be able to gain much clearer oversight and assurance of their risks, but they’ll also be far more efficient with their action planning, too as they’ll be able to avoid duplication and wasted effort by focusing resources on the right actions to achieve the greatest impact on the right outcomes at the right times. And by making the entire process more transparent and collating all relevant data into a single place for one version of the truth, that same solution will almost inevitably improve engagement and help nurture a culture of collective safety mindfulness by enabling everyone to clearly see progress and see risk as an integral part of their day jobs.

Without these benefits, Trusts won’t necessarily find it impossible to become HROs, but they’ll certainly have an uphill struggle ahead of them…

Robert Hobbs

Chief Executive Officer

InPhase’s Chief Executive and Founder, Robert has been the visionary leading InPhase to be one of the UK's leading providers of management, governance and assurance solutions, and helping organisations align their actions and goals more easily and efficiently with InPhase's suite of integrated apps.

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