AnneMarie Benedicto
August 24, 2018

BTOES EXCLUSIVE THOUGHT LEADER PIECE+SLIDE DECK: What is the Role of Leadership in High Reliability Transformation?

anne marie benedicto slide imageCourtesy of Joint Commission Center for Transforming Healthcare, 'What is the Role of Leadership in High Reliability Transformation?' AnneMarie Benedicto has written an article introducing her presentation:

Please click here to download the presentation.

What are High Reliability Organizations?

High reliability in health care means maintaining consistently high levels of safety and quality over time and across all health care services and settings. 

How does a health care organization become highly reliable?  In their 2013 article, Chassin and Loeb refer to three interrelated domains necessary for high reliability transformation: Leadership commitment to zero harm; a fully functional safety culture; and widespread use of Robust Process Improvement® methods including Lean Six Sigma and change management.

Leadership commitment to zero harm is the first step before other changes begin. Commitment is more than a simple agreement that something is a good idea. True commitment that is visible, active, and strong is a lofty goal. Commitment to zero harm requires senior leaders to aim for zero failure rates for all clinical processes.  Yet goal setting is only the beginning.  Leaders then need to make zero harm possible by providing the resources and expertise necessary to achieve the goal.  This is where Robust Process Improvement® (RPI®) fits into high reliability transformation.

Patients are harmed in dishearteningly predictable ways: healthcare acquired infections, patient falls, wrong site surgery, poor communication among caregivers, and others.  Longstanding problems in health care persist because they are complex and multi-factorial, resisting the one-size-fits-all, “best practices” model that assumes a solution that worked elsewhere will be equally effective in a different setting. 

In contrast, RPI® focuses locally, by first finding an organization’s most significant factors that contribute to harm before developing solutions that target these, yielding dramatic improvements.  Lean Six Sigma provides data-driven problem solving, and change management harnesses the expertise of the people affected by the change so they are prepared to create, champion and implement solutions.  RPI® has the breadth and sophistication to navigate complexity.  It is the improvement tool set leaders need to achieve the goal of zero harm.

As leaders deploy RPI® within organizations, it is important to keep the following in mind:

  • Walk the Talk.  As leaders, you set the bar for values and behaviors.  Learn the language of RPI® and use its tools and concepts.  Invest in RPI® practitioners.  Require RPI® for all major initiatives.  This illustrates that you value improvement and recognize its connection to high reliability.
  • Use RPI® to change culture.  True transformation happens not when one person has expertise in a particular skill set but when RPI® becomes the organization-wide language and methodology for improvement.  RPI® reinforces high reliability concepts by making improvement and zero harm accessible and meaningful to the entire healthcare team.
  • Full implementation takes time.  It takes several years for a health system to train all its staff and embed the practice of RPI® so that improvement is a powerful, sustainable force within an organization.  However, the effects of transformation happen as soon as training begins.    

Finally, leaders must also establish a culture of safety, centered on the self-reinforcing cycle of Trust, Report, and Improve. In high reliability organizations, team members trust peers, leadership, and the policies, resources, and systems in place to assist and protect them. They report vulnerabilities, unsafe conditions, inappropriate behaviors, and violations of the organization’s code of conduct and core values. Leaders reward those who speak up, work with those closest to the issue to improve, and then communicate the benefits of these improvements back to involved staff. It is through RPI® that these improvements occur and are sustained over time.

Building an improvement infrastructure is a critical component of a leader’s commitment to high reliability.  Transformation may take time, but so do most things that are truly worth it.

What is the Role of Leadership in High Reliability Transformation?

About Joint Commission Center for Transforming Healthcare

Joint Commission Center for Transforming Healthcare has had considerable benefits with operational excellence since they embarked on this journey 10 years ago, but how have they sustained this in the organization? Download this slide deck to see Anne Marie discuss their journey, and how they define leadership in High Reliability Transformation and achieved significant economic benefit to their organization.

About the Author

annemarie picture

AnneMarie Benedicto, vice president of Joint Commission Center for Transforming Healthcare, specializes in Robust Process Improvement (RPI®and high reliability methods applied to health care clinical and business process.

Prior to her position as vice president, she was chief of staff and executive vice president of Support Operations for the Joint Commission from 2008 through 2015. In that role, she was integral to the building of the company’s internal RPI®program, a systematic, data-driven methodology that incorporates Lean Six Sigma and formal change management. She also led the organization’s first RPI®training within a healthcare facility.  In addition, she directed Center operations from 2008 through 2013, overseeing the development of solutions sets for hand hygiene, hand-off communications, and wrong site surgery, and the design of electronic applications such as the Targeted Solutions Tool® or TST®.

These slides were first presented at the Business Transformation and Operational Excellence World Summit (BTOES). To learn more, please visit

Read More: How Can Healthcare Create High Reliability Organizations Using Continuous Improvement Methodologies?

Read More: Our Journey Toward a High Reliability Organization with the Patient Experience an Importance Focus

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