High reliability & Practice Transformation

Cultivating a culture of excellence Topics Cultivating a culture of excellence Creating a high reliability environment

Cultivating a culture of excellence

Culture is the way we think, act and interact Culture is the shared values and beliefs of a group. Those shared values and beliefs drive how the individuals in the group behave. And those behaviors of the individuals drive the outcomes of the group. In a nutshell, culture is how we think and it’s how we act as a group. There are parts of our culture that are very visible – our mission statement that hangs on the wall; our policies and procedures; the way that we greet each other when we walk down the hall; and the holiday celebrations that we have at our facility. But culture runs deep. There are many unspoken values and beliefs that we share and that are not written down

How behaviors influence Outcomes Adapted from R. Cook and D. Woods, Operating at the Sharp End: The Complexity of Human Error (1994)

Creating Highly Reliable Organizations

High reliability AHRQ - High reliability organizations are entities that operate in complex, high hazards domains for extended periods of time without serious accidents or catastrophic failures. Goal: Creating a culture and processes that radically reduce system failures and effectively respond when failures do occur.

Key Components of High Reliability Organizations

Key Concepts of high reliability organizations (HROs) Sensitivity to operations. Preserving constant awareness by leaders and staff of the state of the systems and processes that affect patient care. This awareness is key to noting risks and preventing them. Reluctance to simplify. Simple processes are good, but simplistic explanations for why things work or fail are risky. Avoiding overly simple explanations of failure (unqualified staff, inadequate training, communication failure, etc.) is essential in order to understand the true reasons patients are placed at risk. Preoccupation with failure. When near-misses occur, these are viewed as evidence of systems that should be improved to reduce potential harm to patients. Rather than viewing near-misses as proof that the system has effective safeguards, they are viewed as symptomatic of areas in need of more attention.

Key Concepts of high reliability organizations (HROs) Deference to expertise. If leaders and supervisors are not willing to listen and respond to the insights of staff who know how processes really work and the risks patients really face, you will not have a culture in which high reliability is possible. Resilience. Leaders and staff need to be trained and prepared to know how to respond when system failures do occur. All these concepts culminate to create a state of mindfulness.

Power Distance in Health Care Barriers to creating a highly reliable environment Power Distance in Health Care Large Distance Relations are autocratic and paternalistic Power acknowledged based on formal, hierarchical positions Small Distance Relations are consultative and democratic Relate as equals regardless of formal positions The next slides apply to why events happen and barriers to giving safe care. Power Distance is a term coined by a Dutch researcher named Gert Hofstede, who defined it as the extent to which the less powerful expect and accept that power is distributed unequally. Hofstede actually measured Power Distance in different countries. He found that in countries like Indonesia, the Philippines and numerous Latin American countries, there is a very high power distance and you simply do not question superiors or cross gender or professional authority gradients. Overall in the United States we have moderate power distance but in certain industries and professional groups, including physicians and nurses, it’s quite high. Key point: Emphasize perceived distance – someone does not need to have a lot of credentials to influence behavior. The perceived distance – not necessarily the real difference – as seen by the subordinate Safety Culture Goal: Use organizational culture to reduce the power distance between groups Adapted from G. Hofstede’s Culture’s Consequences (2001) 12

High Reliability Environment

Tool for changing practice culture Relationship-centered meetings Invest Time in Relationship Building; It Will Pay Large Dividends in Efficiency and Performance. Foster High-Quality Conversation Explore Differences with Openness and Curiosity. In Pursuing Change, Learn from Successes. When Meetings Get Stuck, Interrupt the Pattern Trust the Process; Don’t Try to Control the Outcome. Reproduced with permission from: Anthony L. Suchman and Penelope R. Williamson. Principles and Practices of Relationship-Centered Meetings

Please See Me The following short video, entitled Please See Me, created by patients and caregivers for patients and caregivers, offers a possible solution. Can “Please See Me” become that safe space, where patients and family members can stop the line and share those words if they feel their needs are not being heard or addressed? At the same time, can caregivers use the same phrase when they feel they are not being understood by patients and family members? https://www.youtube.com/watch?time_continue=154&v=380 MiMDoddI