HIGH RELIABILITY IN HEALTHCARE

Agenda1. Case For High Reliability2. Delivering High Reliability to Healthcare3. Characteristics of an HRO4. Planning a High Reliability Journey

Presenters

Tony Gorski | MyRounding | Managing DirectorTony is an award-winning speaker, published author, and recognized subject matter expert in helping health care boards, CEOs, and management teams transform operational performance and create High Reliability Organizations (HROs). Tony co-founded MyRounding Solutions and led Safer Healthcare and has advised leadership teams of Fortune 500 and Russell 2000 Companies in more than 80 countries in operating transformations.

Steve Bachtel | MyRounding | Chief Commercial DirectorSteve has been consulting with health systems, hospitals, and physician’s groups for almost 20 years. Steve’s expertise includes leveraging outcomes to drive patient volume, perfect culture and process to improve patient experience, and engage patient populations pre-, point-, and post-care. Steve’s professional and graduate research work has prepared him to be a thought leader in the healthcare technology space.

Katie Anthony | MyRounding | Marketing Coordinator (Host)Katie has a wide background of marketing expertise including graphic design, campaign strategy, and event planning. For the past five years she has specialized in the healthcare and technology fields working with clients like MGMA, Studer Group, and Hewlett Packard.

HRO Defined

High Reliability: the science of achieving efficient, error-free operation. High Reliability Organization (HRO): an organization with predictable and repeatable systems in place that allow for the consistent execution of operations while catching and correcting potentially catastrophic errors.

1.Case For High Reliability

High risk industries including oil and gas, nuclear power, commercial aviation, banking and the military have adopted HRO principles and strategies to reduce errors and increase operational efficiency and levels of quality and safety.

Healthcare is noticeably missing from this list.

Within the top 10 industries in the US, healthcare has the lowest levels of quality and safety – by far.Aviation Industry = Uber Safe• Number of Commercial Aviation

Flights per Day in US: 30,000• Annual number of commercial

flights: 10.2 million• Average number of deaths

per Year: 14.6• Death Rate per million flights: 1.4

Healthcare Industry = Dangerous• Annual deaths by preventable

medical mistakes: 250,000• Number of lives lost daily to

medical errors: 685• Percentage of patients receiving

wrong medications: 14.6• Chance of a patient receiving

incorrect treatment: 1 in 3

Over 70% of Transformations Fail

Across the healthcare spectrum, over 70% of change and transformation initiatives fail.Understanding why strategies fail is important to avoiding these pitfalls and achieving success.

2.Delivering High Reliability to Healthcare

It all starts with a foundation of structured leadership & accountability

Leaders Identify the Missing LinkSharedVision

Skills /Training Incentives Resources Action

RequiredSuccessfulChange

Skills /Training Incentives Resources Action

Required Confusion

SharedVision Incentives Resources Action

Required Anxiety

SharedVision

Skills /Training Resources Action

RequiredGradualChange

SharedVision

Skills /Training Incentives Action

Required Frustration

SharedVision

Skills /Training Incentives Resources False

Starts

The Sticky Index…Where Do You Score?To make changes “stick” in your organization, take a moment and self-score current team performance:• Grade on 1 to 5 Scale (1 = We Have Issues…………..5 = Top Notch)

Category Example Your ScoreContinued removal of waste and non-value added activities 1Built in quality through “stop and fix” mentality 2Discipline or root cause problem solving 3Ongoing improvement through employee empowerment 2Ability to execute….period. 4

Total Your Score Here 12

The Sticky Index…Where Do You Score?• Grade on 1 to 5 Scale (1 = We Have Issues…………..5 = Top Notch)

Category P1 P2 P3 P4 P5 P6 P7 P8Avg

Score

Continued removal of waste and non-value added activities 2 3 2 1 1 3 2 1

Built in quality through “stop and fix” mentality 3 3 1 1 1 2 1 2

Discipline or root cause problem solving 2 1 3 1 1 1 1 2

Ongoing improvement through employee empowerment 2 2 1 1 1 1 1 2

Ability to execute….period. 2 3 2 2 1 1 1 3

Total Your Score Here 11 12 9 6 5 8 6 10

3.Characteristics of an HRO

Six Characteristics of an HRO• Preoccupation with failure• Commitment to resilience• Sensitivity to operations• Deference to expertise• Reluctance to simplify• Strong safety culture

Stop Chasing Averages

Variability recognizes that processes do not produce identical results every time• Variability may be caused by

identifiable forces acting on the process or by minute fluctuations in the process itself Minutes Hours

Aligning Capabilities and CultureR

apid

Impr

ovem

ent A

bilit

y

4

21

3

5

Facility or DepartmentSTAGE 3CUSTOMER-

DRIVEN

STAGE 2

High Reliability

Organizational Processes

STAGE 1FUNDAMENTALS

PROCESS-DRIVEN1

24

3 5

4.Planning a High Reliability Journey

Planning a High Reliability Journey1. Analyzing existing and potential safety problems2. Designing the model for an HRO3. Collecting and transferring knowledge4. Developing skills5. Launching continuous improvement6. Striving to achieve high reliability

A Structured Journey

Implementing an HRO strategy• At the heart of an HRO strategy

is a solid foundation of leadership development and accountability

• The leadership programming and cultural excellence should drive process improvement, patient safety and OpEx

1. Evidence-Based Leadership℠

2. Process Improvement Engine

3. Patient Safety Culture

4. Operational Excellence

Random Acts of Lean• Value-Stream Mapping• Workplace Organization (5-S)• Six Sigma• Visual Management• Total Preventive Maintenance• Balanced / Lean Scorecard • Kaizen Events• Theory of Constraints• Workouts• Kanban• Reduce Waste – 7 Wastes• Improve Efficiency

• Hejunka Scheduling• Standard Work• Rapid Improvement Events• Operational Method Sheets• Changeover Optimization (SMED)• Case Sequencing• DMAIC• Production Preparation Process• Process Balancing Tools• Electronic Kanban Methods• Benchmarking Practices• Health Care Execution Systems

• Green Belts, Black Belts• Mixed-Model Designs• Drum/Buffer/Rope• RFID/Bar Code Strategies• Flow Rate Management• Cellular Concepts• Rationalization Practices• Demand-Driven Metrics• Flexibility Practices• Process Mapping• Velocity Analysis• Mistake-Proofing (Poka-Yoke)

A Common problem• Pockets of improvement are not tied or affect bottom line• Primarily focused on micro areas with micro results

Standardized Tools & Techniques

HRO Sample Roadmap2016 2017 2018 2019 2020

Assess and Develop Central HRO Platform

Establish Common/Standardized Language

Cultural Awareness and Alignment

Behavioral Reinforcement and Process Repetition

Assess and Establish Process Improvement Engine

Engage and Educate Practice Areas and Leaders

Future StateCurrent StateMetrics TBDMetrics TBD

Transformational Rounds

Transparency Rounds

You Can’t Buy CultureThree Approaches to Transforming your Organization

• A nudge• A hand-hold• Someone does it for you

Thank you.

• Additional questions? Email us at info@myrounding.com• Want a copy of this presentation or webinar recording?

Visit www.slideshare.net/MyRounding• Join us in December for our webinar on MACRA

Register at www.myrounding.com/macra-webinar

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