Achieving High Reliability in Healthcare: A Change Management Challenge for Health Leaders
A highlight of this year’s Healthcare Leadership Improvement Conference in Toronto was a keynote presentation by Chris Power, CEO of the Canadian Patient Safety Institute (CPSI), entitled “High Reliability Leadership: What will it take to create safe systems?”
The talk began with true stories of tragedy and loss – the deaths of an 18-year-old son, a 17-year-old daughter and a newborn child – all as a result of avoidable medical error. These stories resonated deeply with the audience of close to 300 healthcare professionals, and became even more powerful when followed by evidence showing that incidents like these still occur with unacceptable frequency:
- A patient dies in a Canadian acute care hospital from preventable harm every 17 minutes.
- At least one harmful event occurred in one out of every 18 hospital stays in 2014-15.
Chris Power then asked “what other industry would tolerate these statistics?” and provided the sobering answer: “none.”
She acknowledged that we have never delivered safer care, and most times we get it right, but “when we get it wrong we sometimes get it very, very wrong.”
The good news is that solutions for improving safety and reliability are readily available, and there are “pockets of excellence” where healthcare organizations are demonstrating exceptional safety records and evolving steadily into high reliability organizations (HROs).
The pathway to high reliability
Chris Power offered a comprehensive list of “winning conditions” for improving safety. Some addressed the policy level, where we need a safety-focused policy framework and consistent enforcement of regulations, including programs for accreditation and professional certification.
Most of the winning conditions were aimed at organizations – a strong commitment to safety by governance, reliable and comprehensive health information, accountability for performance, non-hierarchical teamwork, and strong patient-led advocacy efforts.
Patient advocacy was cited as particularly important, and a priority for CPSI. Great organizations that are moving forward on this issue fully embrace patient advocacy, and embed patient voices in their work.
Safety and reliability were persistent conference themes, and several speakers contributed concrete tools and strategies.
Mitch Hagins, Studer Group senior coach and speaker, explained how Evidence-Based LeadershipSM (EBL) provides a foundation for high performance and, ultimately, high reliability. EBL is a comprehensive framework of alignment and accountability that enables organizations to align all leaders, teams and functions to measurable goals tied directly to mission, vision and values, and built into strategic planning.
This framework establishes the commitment, accountability and information requirements identified by Chris Power, while providing the focus and clarity needed to optimize resources and accelerate results.
Mitch Hagins identified six markers that guide organizations using EBL along a predictable pathway from achievement of goals to sustainability to high reliability:
- A 90-day planning process ensuring all practices are aligned to goals
- Leader development that gives leaders the skills, knowledge, competencies and information needed to deliver on 90-day plans
- Timely, specific and genuine recognition and appreciation of key behaviours that are essential to high reliability
- Active retention and coaching of talent, and recruitment of new talent based on values
- Standardization: “Diversity in practice leads to disparity in results”
- Coaching, including observation, prescribing of practices and follow-up
Dave Marshall, managing director at Huron, is an author and innovator with expertise in high reliability science as it has evolved over many decades in high-risk industries such as commercial airlines and nuclear power, and as it is now being adapted in healthcare. He defined HROs as “organizations that operate in complex, high-hazard environments for extended periods without serious accidents or catastrophic failures.”
He outlined areas where consistent, predictable excellence is required to achieve and sustain high reliability. These include measurable indicators such as quality, safety, execution and outcomes, as well as supportive cultural characteristics such as trust, engagement, transparency and learning.
All of this requires change. Dave Marshall noted that “the old way isn’t working. High reliability is a new way, and we are going to have to change the system.”
He introduced a proven framework that helps organizations understand, embrace and be successful at change. Successful change has five indispensable components: shared vision, skills/training, incentives, resources, and specification of the actions required.
The challenge of change management
Dave Marshall understands how difficult change can be – over 70 percent of all change and transformation initiatives in healthcare fail.
All speakers acknowledged this challenge and offered insights and advice. Change management, central to high reliability, was a persistent theme.
Chris Power focused on creating a sense of urgency and excitement around the safety agenda. She believes the key lies in shifting people’s feelings, not their thinking “When you connect with somebody on an emotional level and they can see and feel why they should be changing, that’s when the magic happens. Otherwise it is just one more thing we are asking them to do.”
She sees the role of leaders as “creating the conditions so that staff and physicians feel open to change, connected with their hearts and heads, are willing to come along on this journey.”
These same principles were highlighted by Mitch Hagins, who explained how the EBL framework is always grounded in the why of healthcare that is articulated in the organization’s mission, vision, values and strategic plan. He referenced the Healthcare Flywheel, where passion, principles and results cycle continuously to generate positive feedback. Alignment to the why is not just ‘on paper’, but something that is reinforced daily through purposeful, disciplined and sincere behaviours. This is the basis for culture change.
Dave Marshall offered perhaps the best summary of the challenge ahead for healthcare leaders when showing a photograph of a clinician wearing a T-shirt with the slogan “Change is good. You go first.” The picture generated knowing laughs from the audience, and gave him a chance to suggest a new slogan – “Change is good, I’ll go first”