Academic journal article Frontiers of Health Services Management

Achieving High Reliability with People, Processes, and Technology

Academic journal article Frontiers of Health Services Management

Achieving High Reliability with People, Processes, and Technology

Article excerpt

The pace of change in healthcare is faster than ever. As an industry, we do a remarkable job of meeting external challenges and finding solutions to improve the quality ofthe care we provide. We succeed in spite of reimbursement uncertainties that create financial instability for many healthcare organizations. Even so, patients over the past decade have gained a better understanding of quality and cost. Their changing expectations, in part, have prompted healthcare's dedication to creating value-for patients, providers, payers, caregivers, and the community.

Value can be created by meeting the "Quadruple Aim"-improving population health, lowering per capita costs, enhancing the patient experience, and improving provider wellness (Bodenheimer and Sinsky 2014). To address this aim, healthcare leaders must focus on the patient and family through a strategic plan that is driven toward results. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability into an organization's strategy and message. Highreliability organizations (HROs) embody this strategy and center their actions on it. At WellStar Health System, our vision is "to deliver world-class healthcare." Our board set this ambitious goal with the expectation that we will become an HRO and a topdecile health system in safety and quality metrics by 2020.


Reliability has been defined as the number of actions that achieve the intended result divided by the total number ofactions taken (Nolan et al. 2004). The opportunity to reduce waste and variation comes in redesigning processes so that the total number of actions taken is decreased. At WellStar, we use a Lean management strategy to improve processes and sustain favorable outcomes with the following steps (Scoville and Little 2014):

* Define what we are trying to accomplish.

* Understand the gap between the current state and the ideal state.

* Determine a measure (focused on quality, safety, or cost) that will demonstrate a decrease in the gap.

* Develop a change that potentially will lead to the ideal state (e.g., eliminate waste).

* Carry out and test the change using the PDSA (Plan, Do, Study, Act) model.

What is an HRO? WellStar has adopted the Institute for Healthcare Improvement (IHI) definition of an HRO as one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures (Nolan et al. 2004). The goal is to provide safe, effective, patient- and family-centered, timely, efficient, and equitable care (IHI 2017).

A 2013 study showed that the healthcare industry is responsible for more than 400,000 deaths a year due to preventable medical errors, making it the nation's third leading cause of death (James 2013). Addressing preventable errors requires a framework for assessing and improving an organization's reliability. Only then can we create a culture that constantly improves sustainable processes, reduces variations, invests in its people, and uses the most appropriate technology. Such cultures are present in other industries (e.g., aviation, nuclear power, military), and we must learn from them.

In healthcare, unfortunately, there is too much variability in our care of patients. We need to further standardize care, as WellStar has done, through evidence-based care plans that focus on chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes mellitus. In short, we must focus on our people, processes, and technology to become highly reliable.


Since 2007, WellStar has been working to improve trust and engagement among its employees and physicians. By caring for our people, we can improve the care we provide to our patients and the health of our community. Trust is a prerequisite to this initiative because it lies at the core of the team member-leader relationship; organizations with high levels of employee engagement have lower turnover, lower absenteeism, and fewer accidents and patient safety incidents-and they are more productive (Sorenson 2013). …

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