A high reliability organization, or HRO, is an organization that maintains safe and reliable operations in an environment where hazards and normal accidents are to be expected. Recently, many healthcare organizations have moved to the HRO method to improve metrics of safety, effectiveness and timeliness of care. A Framework for Safe, Reliable, and Effective care, is an article written by experts at the Institute for Healthcare Improvement (IHI) and Safe and Reliable Healthcare (SRH) who have outlined, analyzed, and refined the concepts and strategies behind successful frameworks utilized by the safest and most reliable healthcare organizations. Within successful healthcare organizations, whether it be an outpatient facility, acute care facility, or long term care, there are two essential domains that are hallmarks of an HRO: Organizational culture and the Learning System. The culture and learning system of a healthcare organization don’t exist in a vacuum; they are interrelated and each component builds off of another and at the center of this framework are the patients and family.
Leadership, psychological safety, accountability, negotiation, teamwork and communication form the foundation for the cultural domain of the framework. When employees are encouraged to take the time to plan, reflect, communicate, and manage risk when working on a project, this fosters an environment for teamwork and communication. Open communication and discussions about what is acceptable also helps organizations hold employees accountable. Staff members should be able to complete their job knowing that if an issue arises they will be treated fairly and will not be punished for something out of their control, such as a flaw in the system. Just like there may be issues with a process, there are also sometimes conflicts or disagreements that arise between staff at an organization. Negotiation is necessary when multiple individuals, each with a different point of view, disagree on a certain decision or course of action. Similarly, collaborative negotiation is important when including the patient in their care and asking “What Matters to You?” This way we can understand the patient’s needs while also achieving an outcome that matters to the patient.
The Framework describes the best way to solve conflict is through “collaborative negotiation.” This concept allows both parties to describe their position, while simultaneously allowing each party to understand the needs, emotions, and interests of the other. This sort of reflection is likely to allow for the needs of both parties to be met, as well as address any additional questions that have arisen.
An aspect that falls on both the culture and learning domain is leadership. Leaders are all throughout an organization, each with a different role and can be described as formal or informal. Leaders can also foster a culture of psychological safety. Asking questions, introducing new ideas, and looking for feedback are something that employees should feel welcomed to do. In an HRO, suggestions and questions are welcomed and encouraged.
At the heart of the entire framework lies the engagement from patients and families. This is another opportunity where we ask “What Matters to You?” in order to better understand the patient’s worries and priorities. The goal is to discover how to personalize care to meet an individual's unique needs and incorporate simple but meaningful changes into their immediate care.
Source: Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.
November 5, 2021