Mike Harper, Executive Dean of Clinical Practice of the US-based Mayo Clinic, explains: “Compared to the average, we’re doing pretty well; we score on the top of most lists. But are we ‘in control’ yet? No. Are we where we want to be? No. But we’re on our way. We score very high on all of these measures, yet we can do better.”
In a high-risk environment such as healthcare (and, indeed, in aviation, chemical processing and nuclear power), the aim is to become a ‘high reliability’ provider that is focused on consistently excellent outcomes along with prevention of failure. Such organizations align their leadership, core processes and measurement systems, with clear lines of accountability and a common mind-set from the ground floor to the boardroom.
The predominant culture within many providers is one of individual professional autonomy, where clinical excellence is the sole responsibility of doctors, and boards have little influence over quality. Consequently, processes are error-free only 80 percent of the time, outcomes are variable, and patients frequently suffer harm. And without formal monitoring of outcomes, such a state is either unknown or tolerated as the norm. Conversely, once safety and clinical excellence are given higher priority, and responsibility for quality shifts from individuals to multifunctional teams, outcomes improve dramatically and harm rates decline. High reliability organizations typically experience zero errors in more than 99.5 percent of care processes.
‘High reliability’ organizations
The definition of a high reliability organization extends beyond patient safety to encompass quality care – and ultimately value.
Four building blocks towards a ‘high reliability’ healthcare organization
Many healthcare providers lack even the basic building blocks of culture, responsibilities and accountability, process optimization and standardization, and measurement. As they progress to a state of high reliability, each of these blocks has to mature individually and become interdependent with the others, which is no small task, even for the more renowned organizations.
“We are moving towards a more fully integrated operating model, fighting the disintegrating pull of continuous specialization,” says Mayo Clinic’s Mike Harper.
These sentiments are echoed by Ralf Kuhlen, Chief Medical Officer of Helios Kliniken, a German hospital chain with an explicit, public focus on clinical excellence. “Much of this isn’t very sexy. It is the small stuff that matters the most, and it is sometimes hard to get everyone to focus on that.”
What distinguishes these providers is their willingness to push back the frontiers to integrate necessary changes encompassing the building blocks.