Three Misconceptions About High Reliability in Healthcare

When it comes to high reliability in healthcare, is your organization walking the walk or just talking talk?

There’s no question that healthcare providers are all driving toward becoming high-reliability organizations (HROs) but few have achieved that threshold. That’s because when it comes to high reliability, the work is never truly finished – it’s a continuous process that takes constant attention. This and other common misconceptions about high reliability in healthcare can hinder HRO goals.

Let’s flesh out some of these myths…

Myth 1: HROs are focused on fixing mistakes

Not really. HROs are focused on improving outcomes, preventing (not just fixing) mistakes and sustaining those best practices over time. It is critical that providers are able to identify gaps in care and accelerate change quickly. However, successful HROs implement training programs and promote a culture of improvement that encourages communication and teamwork to empower staff.

To do this, health systems must have a strong presence of leadership champions who are visibly involved and active in sustainably removing barriers, as well as focused on aligning specific improvement projects with the organization’s mission and goals. Effective leaders build structured processes and communication forums into their core business so that changes and improvements are drilled into the organization’s culture. This culture also encourages all staff members to speak up and advocate for better, safer care.

For example, to improve care for patients with sepsis, Frederick Memorial Hospital in Maryland engaged a multi-disciplinary hospital task force to create an action plan for recognizing the signs earlier and ensuring appropriate clinical management for severe sepsis. The hospital developed and implemented new emergency department and management guidelines as part of an upgraded sepsis protocol in their facility. After just a few months following the new protocol, Frederick’s sepsis mortality rates dropped nearly 60 percent.

Keys to success in creating a HRO culture:

• Empower all stakeholders with clear roles and responsibilities to instill accountability;
• Create standardized communications and review processes; and
• Ensure that when positive outcomes are achieved there is heightened organizational awareness of the new care delivery models that have been developed, enabling organizations to connect the dots between quality improvement and cost reduction.

Myth 2: HROs are succeeding if they’re avoiding payment penalties

Avoiding payment penalties is only part of the goal. Effective HRO practices can offer powerful upside bonus rewards in today’s value-based payment environment, representing a smart business choice that goes beyond avoiding payment penalties to ensure continued economic viability.

Health systems need to understand and effectively comply with what is driving system-wide quality and cost outcomes they are at risk for and build capabilities to avoid penalties and predict reimbursement in the future. Forecasting the potential financial impact of reimbursement can also help providers prioritize areas of improvement. Predicting reimbursement and payment penalties helps providers understand where to prioritize improvement areas and really focus on sustaining improvements over time.

However, gathering outcomes information across a health system can be an arduous task, especially for reporting required by multiple payment programs. At the same time, leadership is often challenged with that information being accessible holistically, limiting the ability to analyze total performance across all stakeholders in an easy and timely manner.

There is no better way to measure how your healthcare institution is performing than to benchmark your performance against other similar institutions. For example, approximately 250 hospitals participating in Premier’s quality improvement collaborative tap a proven performance improvement methodology based on national data and peer-to-peer benchmarking. When variation in care is identified, the top performers share their best practices with lower performers. Armed with this information, these hospitals are 29 percent more likely to achieve value-based purchasing incentive payments.

Keys to gaining reimbursement opportunities:

• Invest in analytics that have the ability to consolidate quality and cost performance data across the continuum in order to project the clinical and financial impact of value-based payment programs;
• Share and compare clinical outcomes data and best practices with providers outside your organization to pinpoint variation; and
• Understand pertinent federal, state and commercial payment programs, including the Quality Payment Program, which often overlap.

Myth 3: HRO goals are for health system leaders

Actually, in order for a health system to become a true HRO, the goals must be shared with all stakeholders across the continuum to ensure care delivery is consistent from the critical care unit to the skilled nursing facility. There must be alignment between HRO-focused goals and the overall strategic plan of a healthcare organization.

Being a true HRO is a strategic journey, with the patient in mind at all times. Because HROs focus on what the patient needs, and those needs are always evolving, goals are constantly being redesigned and improved upon – especially for those at the frontline of care. Engaging a broad scope of stakeholders, outside the quality department and beyond hospital walls, is key to solving and sustaining performance improvement challenges. The more challenging the healthcare task, the more of a team effort it requires.

When both leaders and staff are keenly aware of the current state of performance to their goals, they are able to respond effectively when system failures occur... because they eventually will. For healthcare organizations, a large part of the drive to fix what’s not working comes from having a sense of purpose.

Keys to engaging all stakeholders with HRO goals:

• Include a range of stakeholders in the development of HRO goals;
• Listen and respond to the insights of staff and others who know how processes really work, and the risks patients face; and
• Remember that behind every diagnosis is a person – someone’s spouse, parent, sibling and/or loved one, with family depending on them, their income and/or their companionship.

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