5 Minutes with The Joint Commission’s
Top Tips for Leaders Who Want to Achieve High Reliability
with Mark Chassin, MD, FACP, MPP, MPH, president and CEO, The Joint Commission
HR: Is the health care industry making progress toward reaching high reliability?
MC: We have definitely made some progress, particularly in areas where we’ve made concerted efforts, such as improving The Joint Commission’s core measures or reducing central line infections. Overall, matched against the magnitude of all the issues, progress has been inadequate and has come only with great effort—project by project. Many health care organizations are experiencing “project fatigue,” because the need for improvement is so great.
Some organizations have committed to a different approach on the journey to high reliability. Their goal is different from adding just another project to the work plan. It is to transform their organizations to achieve the ultimate goal of zero harm to patients and health care workers.
HR: Can you share a bit about The Joint Commission’s research and conclusions studying high reliability organizations in different industries?
MC: The Joint Commission Center for Transforming Healthcare has worked closely for over four years with high reliability experts from academia and many highly reliable industries—ranging from nuclear power to aviation—and developed a practical framework that organizations can use to evaluate their readiness for and progress toward high reliability. These are:
A leadership commitment to achieving the goal of zero harm
A full thickness culture of safety throughout the organization
Rapid adoption and deployment of sophisticated, measurement-driven approaches to process improvement—specifically; Lean, Six Sigma, and change management tools called Robust Process ImprovementTM (RPI).
In each of these areas, we’ve identified specific building blocks that describe what an organization looks like at various stages of maturity and next steps to make progress toward high reliability. Currently, we are partnering with the South Carolina Hospital Association to work with 22 hospitals that are using the High Reliability Self-Assessment Tool (HRST) that we developed to guide leaders through a series of questions about their organizations.
In 2015, we hope to make the HRST available to all accredited organizations and believe it will encourage even more hospitals and health systems to commit to the goal of high reliability.
HR: If you were guiding leaders today, what would you suggest they do operationally to ensure a more highly reliable organization?
MC: Take note of two clues. First, pay close attention to culture. Are you, as a CEO, getting a constant flow of bad news about where your organization’s risks are? Are your leaders coming to you to tell you about unsafe conditions, close calls and adverse events? They must.
Secondly, where does quality show up on the agenda of your Board meetings? Is it the first thing or is it a 10-minute report at the end of the day? Do you as a leader bring adverse events to the Board? That’s critical.
Also, get rid of intimidating behavior. Many times it’s not just a surgeon throwing a scalpel, but rather a condescending tone or telephone hang-up in the face of a question.
A final recommendation is to invest in RPI™ tools. When properly used, these powerful and sophisticated tools can produce enormous improvements in the toughest quality and safety problems—the kind of major improvements that are necessary to move forward high reliability.
All accredited organizations have access to our Targeted Solutions Tools® at no additional cost—for hand hygiene, wrong site surgery, and hand-off communications—that simplify the process by stepping you through how to measure performance, identify barriers to improvement, and solve challenges efficiently. Today, The Joint Commission is much more than an accrediting organization. We are an improvement company.