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Five Ways to Sustain the Gains from High Reliability

A journey toward high reliability begins with organizational readiness and strategically incorporates clinical alignment, evidence-based practices and plans to manage patients across settings. Even with so much momentum, perhaps the most difficult element of care delivery optimization is sustaining the improvement. In fact, more than 50 percent of healthcare professionals in a Premier® survey said their organization's status as a high-reliability organization was either the same or had declined compared to a year prior.

Once stakeholders create and implement a new care protocol together, it can still be easy to slip into old habits weeks or months later. However, improvement is only meaningful if it is maintained, and this requires that organizations continually monitor progress and report metrics to leadership and stakeholders. Doing so will promote organizational awareness of the best practices, accelerate change and help teams strive for excellence.

Here are five standards to have in place to help support the gains:

  1. A culture of high reliability. Successful high-reliability organizations (HROs) have training programs and a culture of improvement that encourage communication and teamwork so that staff are empowered as owners of the new processes. HROs focus on improving outcomes, preventing mistakes and sustaining practices over time – and this culture is imperative for an organization to be able to successfully sustain new practices.
  2. A quality and committee infrastructure. Many organizations already have existing committees such as operational councils, physician councils, the medical executive committee and the quality committee within the board. Leveraging these is important during a care delivery optimization journey so that leaders across the organization are aware of, and engaged in, the efforts and progress.
  3. Accountability. With a strong quality infrastructure in place, accountability typically comes naturally. An existing steering committee, such as a quality improvement council, can keep regular tabs on performance improvement work to survey advances, address challenges and communicate the work broadly.
  4. Measurement. Scorecards are a standard, simple means of showing progress to target goals. They should be powered by robust data analytics that are timely, relevant and accurate so that leaders have appropriate business intelligence to benchmark and set realistic and progressive targets.
  5. A strong project manager. While leaders may be trained in lean principles, their day jobs are to run their departments, so a dedicated project manager who can act as a liaison – and has eyes on the big-picture strategy – will advance efforts more seamlessly. This role is essential to keeping everyone, from leaders to staff, aligned on the game plan and involved in the appropriate day-to-day tactics. The project manager helps to not just oversee the implementation of new processes but can also be the point person to analyze data and plan for circle-backs to ensure stickiness of improvement efforts.

Even with these elements in place, one of the biggest challenges that organizations face in sustaining improvement is an overabundance of priorities. Too many priorities or ones that compete with each other ultimately contribute to an unsustainable environment. To be successful, improvement efforts should align with business priorities and initiatives that ultimately contribute to the organization's long-term strategy and goals.

When tasked with a new project, leaders may want to ask, “How does this initiative contribute to our three-year goal to reduce mortality?” or, “Will this new project align with our current patient safety efforts, which are on pace to improve our CMS Star ratings?” With a proper understanding of how new tactics fit into current targets – and how they align with ongoing performance improvement work – organizations can ensure the right work is prioritized to deliver consistent and optimal care. And, leaders who take the time to regularly discuss how a team’s day-to-day work supports organizational priorities will encourage morale and show how every team member can make a positive impact in the organization.

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