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The Global State of Operational Excellence:
Critical Challenges & Future Trends

130 pages of the most comprehensive study of critical challenges and future trends within Operational Excellence.




What are High Reliability Organizations? It is important we define it.

High Reliability Organizations (HRO) are sometimes referred as the ultimate risk management machine and can be considered as a highly advanced version of continuous quality improvement that extends to the performance of an entire organization.

According to K.E. Weick and K.M. Sutcliffe (from Managing the Unexpected: Sustained Performance in a Complex World), High Reliability Organizations operate under challenging conditions yet experience fewer problems than would be anticipated as they have developed ways of “managing the unexpected” better than most organizations. 

There are some important characteristics of HROs:

  • HROs manage unexpected risks successfully. The practice more than traditional risk management, in which internal and external risks are identified and controls are built for risks alleviation. They create a culture and workforce for a dynamical response to threats.
  • The high-quality performance of HROs is sustained across time. This enables the organization to adapt to changing conditions. 
  • HROs emerge in highly complex environments - they develop techniques and human capacities in order to respond to challenging circumstances that would degrade the performance of less capable organizations.
  • HROs focus on the outcomes that define the organization's mission.

In other words, High Reliability Organizations are organizations that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected based on risk factors and complexity




What is the Role of Leadership in High Reliability Transformation?

by AnneMarie Benedicto

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. 

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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.


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

What is the Role of Leadership in High Reliability Transformation?


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

by Valentine Boving








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

by Bruce Darrow









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