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Christina De Mur Yossi Elaz November 6, 2004

Can Academic Practices Corner the Market on Quality? The High Reliability Organization (HRO) and Anesthesiology. Christina De Mur Yossi Elaz November 6, 2004. Why is there an analogy between industry and OR Environment?. Bringing a product out on schedule with Zero defects

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Christina De Mur Yossi Elaz November 6, 2004

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  1. Can Academic Practices Corner the Market on Quality?The High Reliability Organization (HRO) and Anesthesiology Christina De Mur Yossi Elaz November 6, 2004

  2. Why is there an analogy between industry and OR Environment? • Bringing a product out on schedule with Zero defects • Multiple Disciplines are needed • Life is depending on the decision made by the Team • Diagnosis • Analysis • Intervention

  3. Costs Quality Current Situation In the HealthCare system by: Innovation Process-Optimizing Effective Organization

  4. What is a High Reliability Organization • ‘HROs are organizations that operate under high stress, high tempo, ‘all weather’ conditions with an extremely low error rate of less than 1:1,000,000’ • Some of the more well known HROs are the airline industry, nuclear power plants, aircraft carriers

  5. HRO Characteristics • Safety is cornerstone philosophy • Culture to minimize impact of errors • Team based • Anticipate delays and mitigate them • Create a system of checks and balances • Common goal(s)

  6. What do we know about the OR Environment? • Life and Death Situation • Sudden changes between routine and emergency • Potential for error and disaster exists! • Very decentralized • Lots of players • Lots of equipment and supplies • Average # people in a OR suite is 6-10

  7. Applied technology in an OR

  8. Typical ‘administration’ mentality to fix the problems? • Goals • TQM/CQI Programs • Creating Task forces • Hire More people • Buy More equipment (especially innovative technology) • Renovate ORs and make them bigger • Workflow optimization

  9. Radiologie diagnostically process Labor . . . ECG OP, Onko, Cardio Ressourcenplanung ADT POE therapeutic process Administrative process Clinical process Station Dokument Abrechnung ADT Intensiv Rehabilitation supply Niedergelassener Perspective: Process-Optimizing

  10. What about Organizational Changes?How is the Industry dealing with the High Reliable Organizational Models?

  11. 0 0 0 I I I Ii Ii Ii Iii Iii Iii Iv Iv Iv They Select the Concepts That Best Meet Both Customer Needs and Company Capability They Strategically Plan and Develop These ConceptsInto Full Solutions They Generate ConceptsThat SolveCustomers’ Problems Best practice companies – Customer Inspired Development AHA!!—Now I Understand! They Understand the Fundamentals of Customers’Problems In Focused Areas

  12. What has Industry learned from HROs? • Empowering employees • Cross-function teams • Define/implement BEST practices • Establish metrics • Education • Audits

  13. What can the OR (healthcare) learn from HROs? • Teach us what to pay attention to • How to process vast quantities of data • How to maintain alertness

  14. The article: Tackling the complex OR environment • Our article suggested Anesthesia should be the champion for change • Why? • You are there 10+ hours a day, at least 5 days a week • The OR is your office • You interact with all areas of the hospital • You know what is really going on • You are the problem solvers, trained to think fast

  15. The conductor • Not related to technology • Not just about $$ or having more people or building more ORs • Its about an energy level, teamwork, people committed to doing things a different way – a new CULTURE • Needs to be empowered by hospital administration • Has the Vision of a better way

  16. What is the reward? • Different environment • Incorporation of HRO-like qualities • Heightened awareness to minimize adverse outcomes • Increase efficiency • Beautiful music with your different ‘sections’ in the complex OR environment

  17. What can you do next to become the ‘conductor’? • Start with the APSF Spring 2003 newsletter, lots of terrific articles and great starting point • www.apsf.org website • APSF Winter 2003 summarized HRO workshop held before ASA • Leapfrog and Institute for Safe Medication Practices

  18. We certainly do not want to go this far with our comparison to the Industry

  19. Remember – If we continue to do things the same way…why should we expect to see different results!

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