Sister Gonzales Duffy Lecture Award Seven Springs, PA October 12, 2017 Personal High Reliability

Transcription

1 Thank You

2 Sister Gonzales Duffy Lecture Award Seven Springs, PA October 12, 2017 Personal High Reliability Allen J. Vaida

3 Disclosure Allen J. Vaida declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program

4 Pharmacist Learning Objectives Describe the attributes of a high reliable organization Explain the concept of appreciative inquiry Identify how appreciative inquiry may assist with achieving high reliability Apply high reliability into personal practice

5 Technician Learning Objectives Describe why high reliability is important in health care Identify concepts of high reliability in your current practice Describe appreciative inquiry Identify what you do best can help improve medication safety

6 High Reliability Organizations (HRO) Operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic events. Cultivate a culture of persistent and collective mindfulness look for and report problems, no matter how small. within the organization. Appreciate that safety is emergent versus static new threats emerge all the time Display resilience safety over performance pressures. Often cited as the airline industry or nuclear power industry

7 Different Focus Change from a find and fix Concentrate on enabling things to go right Appreciate everyday performance succeeds more than it fails Proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter

8 Characteristics of a HROs 1.Preoccupation With Failure 2.Reluctance to Simplify 3.Sensitivity to Operations 4.Commitment to Resilience 5.Deference to Expertise

9 Preoccupation With Failure Everyone is aware of and thinking about the potential for failure. People understand that new threats emerge regularly from situations that no one imagined could occur, so all personnel actively think about what could go wrong and are alert to small signs of potential problems. The absence of errors or accidents leads not to complacency but to a heightened sense of vigilance for the next possible failure. Near misses are viewed as opportunities to learn about systems issues and potential improvements, rather than as evidence of safety.

10 Reluctance to Simplify People resist simplifying their understanding of work processes and how and why things succeed or fail in their environment. People in HROs understand that the work is complex and dynamic. They seek underlying rather than surface explanations. While HROs recognize the value of standardization of workflows to reduce variation, they also appreciate the complexity inherent in the number of teams, processes, and relationships involved in conducting daily operations.

11 Sensitivity to Operations People in HROs strive to maintain a high awareness of operational conditions. This sensitivity is often referred to as "big picture understanding" or "situation awareness." People cultivate an understanding of the context of the current state of their work in relation to the unit or organizational state i.e., what is going on around them and how the current state might support or threaten safety.

12 Commitment to Resilience People in HROs assume the system is at risk for failure, and they practice performing rapid assessments of and responses to challenging situations. Commitment to resilience is rooted in the fundamental understanding of the frequently unpredictable nature of system failures. Teams cultivate situation assessment and cross monitoring so they may identify potential safety threats quickly and either respond before safety problems cause harm or mitigate the seriousness of the safety event.

13 Deference to Expertise People in HROs appreciate that the people closest to the work are the most knowledgeable about the work. Thus, people in HROs know that in a crisis or emergency the person with greatest knowledge of the situation might not be the person with the highest status and seniority. Deference to local and situation expertise results in a spirit of inquiry and de-emphasis on hierarchy in favor of learning as much as possible about potential safety threats. In an HRO, everyone is expected to share concerns with others and the organizational climate is such that all staff members are comfortable speaking up about potential safety problems.

14 Organization Requirements to Achieve High Reliability Leadership Commitment Needed from the top (Board) down Positive Safety Culture Throughout the organization Robust Process Improvement Commitment, support, and resources

15 Appreciative Inquiry Appreciative Inquiry is a change management approach that focuses on identifying what is working well, analyzing why it is working well and then doing more of it. The basic tenet of Appreciative Inquiry is that an organization will grow in whichever direction that people in the organization focus their attention.

16 Appreciative Inquiry Choose to seek out what is already good and right about the individual, team, or organization. What do we want more of What are our strengths

17 Components of Appreciative Inquiry 1.DISCOVER: The identification of organizational processes that work well. 2.DREAM: The envisioning of processes that would work well in the future. 3.DESIGN: Planning and prioritizing processes that would work well. 4.DESTINY (or DEPLOY): The implementation (execution) of the proposed design

18 Achieving Personal High Reliability Can we personally exhibit the characteristics of HROs into our normal work routines? Can we as an n of one achieve high reliability? Can we also use the overall theory of Appreciative Inquiry to help us maintain high reliability? Can we have an effect on those around us to achieve high reliability?

19 Personal High Reliability High reliability people have a preoccupation with failure. Do I think of ways work processes might break down and do I encourage those around me to do the same? Do I share my concerns for potential failures and ask those around me what their concerns may be? Do I regard near misses and identifying hazardous conditions as good news (not always a failure) and promote that safeguards we put in place are working? At the end of the day do I think what I may do better to prevent errors from reaching patients and possible harm?

20 Personal High Reliability High reliability people are reluctant to accept "simple" explanations for problems. Do I resist the temptation to simplify when something goes wrong? Do I try to dig deeper into finding the real source of the problem? Do I ask those around me questions and encourage them to ask me questions? At the end of the day do I think about those broken processes that I, a colleague, or our organization may have fixed and feel good about it? Do I think about how I can do more of that?

21 Personal High Reliability High reliability organizations are sensitive to operations. Do I appreciate and understand how processes and systems affect my organization and staff around me? Do I try to learn more of how what I do may impact those around me? Do I maintain an awareness of what is and isn t working? Do I spend time to learn more about the interaction of the whole team? Do I ask questions of co-workers to better my understanding?

22 Personal High Reliability High reliability people are resilient. Do I stay the course even when things around me may be failing? Do I avoid at risk behavior and encourage those around me to do the same? Do I think back on situations where I prevented errors from reaching a patient? Do I think about what I may have done in those situations to prevent a possible catastrophe and build upon it?

23 Personal High Reliability High reliability people defer to expertise. Do I listen to listen to people who have the most developed knowledge of the task at hand even if I may have more seniority? Do I encourage others to seek out additional help if I don t have the answer? Do I think back on what individuals may have helped me to prevent an error? Do I seek out more colleagues who may have more expertise than me?

24 My Conclusion We can achieve many of the characteristics of high reliability even if our organization may not have fully embraced the concept or begun the journey? We can achieve it individually as an high level administrator, manager, middle manager, supervisor, front line staff? We can direct and motivate others if we focus on what we have done well and build upon it. Our personal high reliability will rub off on others.

25 References Weick KE, Sutcliffe KM. San Francisco, CA: John Wiley & Sons; 2015 Chassin MR, Loeb JM. The Milbank Quarterly, Vol. 91, No. 3, 2013 (pp ) Cooperrider, D. L., Sorensen, P.F., Whitney, D., Yaeger, T. Appreciative Inquiry: Rethinking Human Organization Toward a Positive Theory of Change. (Chicago IL: Stipes Publishing, 2000) Cooperrider, D. L., Sorenson, P.F., Yaeger, T., & Whitney, D. Appreciative Inquiry: An Emerging Direction for Organization Development. (Chicago, IL: Stipes Publishing, 2001). final.pdf