Cultural Building Blocks of High Reliability in Healthcare:

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Ferdinand Williams
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1 Cultural Building Blocks of High Reliability in Healthcare: Where do we stand? University of Southern Maine Patient Safety Academy September 8, 2016 Presenters Jeff Brown MEd Director of Continuous Quality Improvement Felicity Homsted Pharm D Chief Pharmacy Officer Penobscot Community Healthcare fhomsted@pchc.orgg Tina Scott RN, MSN System Director Clinical Performance Improvement tscott2@emhs.org Lynn Thornton RPh Clinical Pharmacist Specialist lynnthornton@emhs.org Angela Gibbs RN MSN System Director Patient Safety and Quality argibbs@emhs.org 1

2 Objectives Participants will be introduced to the concept and definition of high reliability Participants will be introduced to cultural, organizational, and practice traits that underpin high reliability Participants will identify and describe the current state of safety management in healthcare using cultural, organizational, and practice traits that underpin high reliability Background University California-Berkley researchers examined links among aircraft carriers, air traffic control, and nuclear power operations Adaptive learning and reliable performance. Normal Accident Theory versus High Reliability Theory Prevention (anticipation) and Resilience (containment) 2

3 High Reliability Healthcare Systems and Organizations Create a state of collective mindfulness that produces an enhanced ability to discover and correct errors before they escalate into a crisis. Weick and Sutcliffe 2007 Situational Awareness: Fundamental to High Reliability Developing Situational Awareness Level 1: Perception of elements Level 2: Comprehension of meaning Level 3: Projection Situational Awareness Derailed Environmental Threats to Situational Awareness What s next 3

4 Creating a State of Mindfulness Using the five principles of HROs Preoccupation with Failure Reluctance to Simplify Sensitivity to Operations Commitment to Resilience Deference to Expertise 7 Creating a State of Mindfulness Resulting in Reliability Anticipation (Stay out of Trouble) Preoccupation with Failure Reluctance to Simplify Sensitivity to Operations Containment (Get out of Trouble) Commitment to Resilience Deference to Expertise State of Mindfulness High Reliability Consistent Safe Quality Care 8 4

5 Preoccupation with Failure Attention to close calls and near misses Focus more on failures than successes Operating with a heightened awareness Proactive and preemptive analysis and discussion Employees are trained to look for abnormalities, recognize defects, and act Reluctance to Simplify Interpretations Solid root cause analysis practices Deliberately questioning assumptions Each potential risk is investigated with the same level of intensity Staff feel open to ask questions and refrain from making assumptions Diverse team is engaged to make an assessment 5

6 Sensitivity to Operations Situational awareness Carefully designed change management processes Systems and processes to communicate all risks across the organization Seeing what we are doing regardless of intentions, designs, and plan Commitment to Resilience Mishaps and errors do not disable an organization Understand unanticipated events do occur Continually devoted to corrective action plans and training Develop a capacity to cope with events 6

7 Deference to Expertise Authority follows expertise Listen to experts at the front line Decision-making authority is delegated to the expert in the area in which the problem has arisen Improves the organization's ability to respond quickly to unexpected events Focus on Achieving High Reliability A consistent excellence over long periods of time requires: -Commitment to the goal of high reliability -Development of a culture that supports high reliability -Development of strong and effect education programs and modeling of high reliability concepts -Development of strong and effect tools for process improvement 14 7

8 Development of a Culture That Supports High Reliability Leadership must commit to a goal of zero harm HRO principles must be integrated within the organization to develop a culture of safety Adopt a robust process improvement program to improve its quality care and outcomes In a culture of safety and quality, all individuals are focused on maintaining excellence in performance Presenters Jeff Brown MEd Director of Continuous Quality Improvement jbrown@mepca.org Felicity Homsted Pharm D Chief Pharmacy Officer Penobscot Community Healthcare fhomsted@pchc.orgg Tina Scott RN, MSN System Director Clinical Performance Improvement tscott2@emhs.org Lynn Thornton RPh Clinical Pharmacist Specialist lynnthornton@emhs.org Angela Gibbs RN MSN System Director Patient Safety and Quality argibbs@emhs.org 8

9 Discussion 9

Culture and Reliability

North American Electric Reliability Corporation Improving Human Performance on the Grid Workshop and Conference March 2015 Culture and Reliability Rizwan Shah Organizational Culture Program Advisor US