Becoming a High Reliability Organization (HRO) Operational advice for Hospital Leaders

1. Becoming a High Reliability Organization (HRO) Operational advice for Hospital Leaders PROF DR. HESHAM ELKHOLY - Chairman of the Chamber of Private Sector Healthcare Providers Presented By Prof Dr NAGWA El HOSSEINY

2. Contents • Definition of high reliable organization (HRO) • How have HROs been defined? • What are the key features of HRO model? • Are there any studies of healthcare HROs? • What are the practical considerations for leaders in healthcare? • Current Challenges in Egypt • Conclusion

3. DEFINITION • High reliability organizations (HRO) are organizations that work in situations that have the potential for large-scale risk and harm, but which manage to balance effectiveness, efficiency and safety. • They also minimize errors through teamwork, awareness of potential risk and constant improvement.

4. How have HROs been defined ? ‘High reliability organization’ is a consistently reliable organization that operates in a complex environment where accidents might be expected to occur frequently, but which manages to avoid or seeks to minimize catastrophes. • Energy • Aviation and transport • Military and space • Fires and disasters • Healthcare • Education.

5. WHAT ARE THE KEY FEATURES OF HRO MODEL 1. High reliability organizations operate in complex physical environments as well as unforgiving social and political environments. 2. High reliability organizations use processes and technologies that have the potential for risk and error. 3. There is a focus on continuous improvement. 4. There is a good safety culture, with leadership and frontline staff taking shared responsibility. 5. Risk Management – whether or not the organization correctly perceives operational risks and takes corrective action 6. Leadership and Supervision -- policies and procedures and communication processes used to proactively mitigate risks 7. Teams are adept at quickly building creativeresponses to failure.

6. What about HRO in healthcare? • There are a small number of case studies outlining how specific healthcare services might fit the definition of high reliability organizations. • High reliability in HEALTHCARE means that at your hospital ,patients always receive exactly the care they need and the care is provided in systems that have no inefficiencies or waste. • High reliability is an ongoing process that is never perfect, complete, or total.

7. Hospital leaders must juggle many operational factors that affect their facilities

8. The five specific concepts that help create the state of Mindfulness that is needed for Reliability Mindful organization means that individuals to interact continuously , and proactively triggers actions that prevent errors and crises.

9. 1-Sensitivity to operations Sensitivity to operations encompasses more than checks of patient identity, vital signs, and medications. It includes awareness by staff, supervisors, and management of broader issues that can affect patient care, ranging from how long a person has been on duty, to the availability of needed supplies,

10. 2-Reluctance to simplify • Oversimplifying explanations for how things work is risky, could lead to errors , or failing of the system, that ends up by placing a patient at risk. • HROs refuse to simplify or ignore the explanations for difficulties and problems that they face

11. 3-Preoccupation with failure • A preoccupation with failure means that near misses are viewed as invitations to improverather than as proof that a system has enough checks to prevent a catastrophic failure. • HROs are focused on predicting and eliminating catastrophes rather than reacting to them

12. 4-Deference to expertise • Decisions should be made on the front line staff where the best knowledge of the situation exists . • HROs cultivate a culture in which team members and organizational leaders defer to the person with the most knowledge relevant to the issue they are confronting , irrespective to the hierarchy

13. 5-Resilience • A good boater never leaves the dock without preparing for many situations that are unlikely but possible. Oars, pump, lifejacket, and fire extinguisher ensure that the boater can quickly respond to unexpected system failures

14. what are the practical considerations for leaders in healthcare? High Reliability can be achieved through: • Improved operational efficiency, • Consistent excellence in patient care • And therefore, high reliability.

15. Consistent excellence in patient care • DAFH is always striving for excellence in services given to the patients since it was opened,1999 • For this vision ,the strategy DAFH is to follow the JCI quality standards of care • DAFH hospital staff were able to achieve JCI accreditation 3 time( in the years 2005,2008,2011) The CONCEPT is Continuous Quality Improvement

17. In Patient Census Activity DAFH, 2000 - 2012 Out Patient Census Activity DAFH, 2000 - 2012 Number Number NO. Bed Occupancy Rate DAFH, 2000 - 2012 Average Length of Stay DAFH, 2000 - 2012 % Days

18. Gross Unadjusted Mortality Rate DAFH, 2008 – 2012 Target <3 NO. %

19. Hospital Acquired Infection/1000 Patient Days, 2009 – Jan 2013 2009 2010 2011 2012 May

21. RATE OF BED SORES; DAFH, 2008 - 2012 2008 MEAN = 1.53 2009 MEAN = 1.47 2010 MEAN = 1.27 2011 MEAN = 0.74 2012 MEAN = 0.48

22. Medication Errors per 1000 DosesDAFH, JAN-DEC 2012

23. 2010 2009 2006 2007 2008 Dispensing Error Doses DAFH, 2006 - 2010

24. Total No. of Patient Complaints 2007 2008 2009 2010 2011 2012 Mean= 288 Mean= 266 Mean= 204 Mean= 149 Mean= 83 Mean =89.2 • e Jan 2007 – DEC. 2012

25. Current Challenges • Egypt now , there are many progressively increasing challenges facing All healthcare managers. • The increase risk of high cost: • Increase price and unavailability of supplies • Currency instability that affect the buying the supplies • The country political situation that’s affecting the economic status of the country

26. Successful Risk Management Culture Proactive Risk Preparedness • Proactive Risk Identification • Expecting the possible Risks in each division in the organization (e.g. Finance, Security Dept., HR, Medical Supplies, IT,.. etc) • Proactive Risk Analysis • Prioritization of the defined Risks according to high volume and high risk (using different tools like Brain Storming, Multi-voting, etc.) and dividing the defined risks into 3 phases (Yellow – Orange – Red) according to severity. • Proactive Risk reduction strategies and Control • Putting action plans with clear responsibilities for each defined Risk in each phase • Financing Proactive Risks • Securing the costs of the risk exposures (e.g. securing a budget in a safe place in the organization in case the Banks are closed for long period)

27. Why Healthcare Leaders Need to Act Now All leaders need to use the concept of HRO because of 3 specific trends that are available: 1-Public awareness of medical errors and quality 2-Health information technology; that can assist in monitoring performance , adjusting medications….. 3-Emergence of quality improvement methodologies which is an important step for continuous improvement

28. CONCLUSIONS • Health care organizations are at different stages of maturity on the path to high reliability. • The first step is to conduct a self-assessment of the current state of leadership, safety culture, and capacity to execute Robust Process Improvement. • By performing an assessment, health care organizations can gain an overall understanding on where to focus their improvement efforts. • According to “The Ongoing Quality Improvement Journey: Next Stop, High Reliability,”

29. Pyramid of Excellence of Healthcare Organizations

30. Thank You