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High Reliability Organization

Have you heard that before? While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly. Yes, even though the statement appears to be sound, the real question is what about the patient's health if not life? Is it in danger? I am sure you might come up with many similar questions. So, where do we start? Albert Einstein once said. “The world we have created is a product of our thinking, it can’t be changed without changing our thinking”. Perhaps, it is time to revisit our thinking.

This blog is dedicated to a mindset shift from profit to purpose, from hierarchies to networks, from controlling to empowering, from planning to experimentation and from seclusion to transparency. And for that, I would like to introduce to you the High Reliability Organization.

1. Defining High Reliability

It’s a concept that comes from the study of industries that have maintained very high levels of safety over a very long period of time; like commercial aviation. It means consistent excellence. What does it mean for Healthcare? It is establishing near-zero rates of failures for critical quality processes and making sure that they stay at that level for performance across all services over a long period of time. The definition was written by Mark R. Chassin, MD.

For the purpose of this blog, how about we replace the word concept with a system or even science. Yes, High Reliability is the system or science of achieving an effective and efficient error-free environment under desired conditions. The conditions are set so that each process is predictable and repeatable / reproducible during the execution.

2. Why High Reliability?

You already know this. The strength of the system is measured by its weakest member. Let’s look at the marketing mix example. In this oversimplified example I will make an assumption that “things” are happening in series and relying on each other.

Example 1: Product “A” functionality is 0.90 reliable. Product “B” functionality is 0.95 reliable. And product “C” is 0.99 reliable. The overall reliability of a system is 0.90 x 0.95 x 0.99 = 0.85

Example 2: Payment Arrangement “A” is 0.99 reliable. Payment Arrangement “B” is 0.70 reliable. Payment Arrangement “C” is 0.80 reliable. The overall reliability of a system is 0.99 x 0.70 x 0.80 = 0.55

Example 3: Customer Service “A” is 0.50 reliable. Customer Service “B” is 0.60 reliable. Customer Service “C” is 0.70 reliable. The overall reliability of a system is 0.50 x 0.60 x 0.70 = 0.21

As you can see in the above examples, the strength (reliability) of the system is dependent on the reliability of its members.

I believe we are in Healthcare to save lives, restore health, and avoid harm. Already in 1999, the Institute of Medicine published a paper titled “To Err is Human”. In this report, we learn that Healthcare is not as safe as we wish. In 2001, the Institute of Medicine published a second paper titled “Crossing the Quality Chasm”. In this report, we learn that the Healthcare does not always provide consistently high-quality care. In addition, they identified six dimensions of quality:

The above is just the tip of an iceberg. For Healthcare to be reliable, it needs a system, where processes and members, meaning people work in harmony and each one of them is accountable and responsible for its action and works to its highest potential. As W. Edwards Deming said, “If we can’t describe what we do as a process, we don’t know what we are doing”.

3. A practical framework for improvement

The Joint Commission constructed a framework that health care organizations can use to accelerate their progress toward the ultimate goal of zero harm and becoming a High Reliability Organization.

4. Characteristics of High Reliability Organization

The below characteristics are essential for avoiding any failures and catastrophic events. Perhaps, you will not face such risk but applying these characteristics will help teams and individuals to reach the desired conditions.

5. Planning a High Reliability journey

When it comes to planning, I am always reminded of the 8-step process for leading change which was carefully crafted by John P. Kotter. The basis comes from the countless observations and encounters with leaders and organizations as they were trying to transform or execute their strategies. The picture depicts the 8-step process for leading change.

Although the 8-step process for leading change is a top down approach, without required urgency, coalition, vision, communication and action it is not achievable and sustainable.


In closing, it’s my hope that your hearts and minds are open to striving for high reliability whether individually or in an organization. It starts with me and you by having a purpose, where I and you are open to collaboration and willingness to empowerment and then through a series of experiments, we learn daily while maintaining open channels of communication and transparency. High Reliability Organization is a learning organization on the path to zero harm with a culture of hope, trust, love, and care.




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