1. Prof Dr NAGWA El HOSSEINY
Becoming a High Reliability Organization (HRO) Operational advice for Hospital Leaders
PROF DR. HESHAM ELKHOLY - Chairman of the Chamber of Private Sector Healthcare Providers
Presented By
Prof Dr NAGWA El HOSSEINY

2. Contents What are the key features of HRO model?
Definition of high reliable organization (HRO)
How have HROs been defined?
What are the key features of HRO model?
Are there any studies of healthcare HROs?
What are the practical considerations for leaders in healthcare?
Current Challenges in Egypt
Conclusion

3. DEFINITION
High reliability organizations (HRO) are organizations that work in situations that have the potential for large-scale risk and harm, but which manage to balance effectiveness, efficiency and safety.
They also minimize errors through teamwork, awareness of potential risk and constant improvement.

4. How have HROs been defined ?
‘High reliability organization’ is a consistently reliable organization that operates in a complex environment where accidents might be expected to occur frequently, but which manages to avoid or seeks to minimize catastrophes.
Energy
Aviation and transport
Military and space
Fires and disasters
Healthcare
Education.

5. WHAT ARE THE KEY FEATURES OF HRO MODEL
1. High reliability organizations operate in complex physical environments as well as unforgiving social and political environments.
2. High reliability organizations use processes and technologies that have the potential for risk and error.
3. There is a focus on continuous improvement.
4. There is a good safety culture, with leadership and frontline staff taking shared responsibility.
5. Risk Management – whether or not the organization correctly perceives operational risks and takes corrective action
6. Leadership and Supervision -- policies and procedures and communication processes used to proactively mitigate risks
7. Teams are adept at quickly building creative responses to failure.

6. What about HRO in healthcare?
There are a small number of case studies outlining how specific healthcare services might fit the definition of high reliability organizations.
High reliability in HEALTHCARE means that at your hospital ,patients always receive exactly the care they need and the care is provided in systems that have no inefficiencies or waste.
High reliability is an ongoing process that is never perfect, complete, or total.

7. Hospital leaders must juggle many operational factors
that affect their facilities

8. The five specific concepts that help create the state of Mindfulness that is needed for Reliability
Mindful organization means that individuals to interact continuously , and proactively triggers actions that prevent errors and crises.

9. 1-Sensitivity to operations
Sensitivity to operations encompasses more than checks of patient identity, vital signs, and medications. It includes awareness by staff, supervisors, and management of broader issues that can affect patient care, ranging from how long a person has been on duty, to the availability of needed supplies,

10. 2-Reluctance to simplify
Oversimplifying explanations for how things work is risky, could lead to errors , or failing of the system, that ends up by placing a patient at risk.
HROs refuse to simplify or ignore the explanations for difficulties and problems that they face

11. 3-Preoccupation with failure
A preoccupation with failure means that near misses are viewed as invitations to improve rather than as proof that a system has enough checks to prevent a catastrophic failure.
HROs are focused on predicting and eliminating catastrophes rather than reacting to them

12. 4-Deference to expertise
Decisions should be made on the front line staff where the best knowledge of the situation exists .
HROs cultivate a culture in which team members and organizational leaders defer to the person with the most knowledge relevant to the issue they are confronting , irrespective to the hierarchy

13. 5-Resilience
A good boater never leaves the dock without preparing for many situations that are unlikely but possible. Oars, pump, lifejacket, and fire extinguisher ensure that the boater can quickly respond to unexpected system failures

14. what are the practical considerations for leaders in healthcare?
High Reliability can be achieved through:
Improved operational efficiency,
Consistent excellence in patient care
And therefore, high reliability.

15. Consistent excellence in patient care
DAFH is always striving for excellence in services given to the patients since it was opened,1999
For this vision ,the strategy DAFH is to follow the JCI quality standards of care
DAFH hospital staff were able to achieve JCI accreditation 3 time( in the years 2005,2008,2011)
The CONCEPT is Continuous Quality Improvement

17. NO. In Patient Census Activity DAFH, 2000 - 2012
Out Patient Census Activity
DAFH,
Number
Number
NO.
Bed Occupancy Rate
DAFH,
Average Length of Stay
DAFH, %
Days

18. Gross Unadjusted Mortality Rate
DAFH, 2008 – Target <3
NO. % 18

19. Hospital Acquired Infection/1000 Patient Days, 2009 – Jan 2013
2010
2011
2012
May 19

21. RATE OF BED SORES; DAFH, 2008 - 2012
MEAN = 1.53
2009
MEAN = 1.47
2010
MEAN = 1.27
2011
MEAN = 0.74
2012
MEAN = 0.48

22. Medication Errors per 1000 Doses DAFH, JAN-DEC 2012

23. Dispensing Error Doses DAFH, 2006 - 2010
2009
2010
2006
2007
2008

24. Total No. of Patient Complaints
2007
2008
2009
2010
2011
2012
Mean= 288
Mean= 266
Mean= 204
Mean= 149
Mean= 83
Mean =89.2 e
Jan 2007 – DEC. 2012 24

25. Current Challenges
Egypt now , there are many progressively increasing challenges facing All healthcare managers.
The increase risk of high cost:
Increase price and unavailability of supplies
Currency instability that affect the buying the supplies
The country political situation that’s affecting the economic status of the country

26. Successful Risk Management Culture Proactive Risk Preparedness
Proactive Risk Identification
Expecting the possible Risks in each division in the organization (e.g. Finance, Security Dept., HR, Medical Supplies, IT,.. etc)
Proactive Risk Analysis
Prioritization of the defined Risks according to high volume and high risk (using different tools like Brain Storming, Multi-voting, etc.) and dividing the defined risks into 3 phases (Yellow – Orange – Red) according to severity.
Proactive Risk reduction strategies and Control
Putting action plans with clear responsibilities for each defined Risk in each phase
Financing Proactive Risks
Securing the costs of the risk exposures (e.g. securing a budget in a safe place in the organization in case the Banks are closed for long period)

27. Why Healthcare Leaders Need to Act Now
All leaders need to use the concept of HRO because of 3 specific trends that are available: 1-Public awareness of medical errors and quality 2-Health information technology; that can assist in monitoring performance , adjusting medications….. 3-Emergence of quality improvement methodologies which is an important step for continuous improvement

28. CONCLUSIONS
Health care organizations are at different stages of maturity on the path to high reliability.
The first step is to conduct a self-assessment of the current state of leadership, safety culture, and capacity to execute Robust Process Improvement.
By performing an assessment, health care organizations can gain an overall understanding on where to focus their improvement efforts.
According to “The Ongoing Quality Improvement Journey: Next Stop, High Reliability,”

29. Pyramid of Excellence of Healthcare Organizations
HRO
Continuous Quality Improvement
Indicators – Auditing - Improvement
Improve Quality & Safety
Training – Standards compliance
Self Assessment
Culture and practice of quality and safety

30. Thank You