Embracing High-Reliability: The Missing Ingredient for True Transformation

By Jennifer Sipert MS, CPHQ, RDMS, RVT

After 30 years of efforts, we are still missing the secret ingredient.

 “There’s a new program coming, and it has to do with safety. I think it’s perfect for you, and you’re really going to like this stuff.” Those words from a hospital executive in 2013 marked the beginning of a journey that would transform not only my career but also my perspective on healthcare systems.

 A couple of months later, I found myself in a large conference room with other leaders from my organization. The anticipation and anxiety were palpable. We had been hearing whispers about this new program, High-Reliability Organization (HRO), for months. The responses were mixed. Some were dismissive, calling it “another flavor of the month,” while others were cautiously optimistic but doubtful about the hospital's ability to follow through.

 Despite my reservations, I tried to keep an open mind. The promises of HRO made me hopeful, but the organization had a poor track record of sustaining new initiatives. Programs would be launched with great fanfare, only to fizzle out within a year or two, leaving behind nothing but a few old flyers on bulletin boards.

 The initial four-hour introduction to HRO left me inspired yet overwhelmed. I was excited about the vision of improving patient outcomes but unsure how we would achieve it. Despite this uncertainty, my enthusiasm landed me a position as the Patient Safety Manager, tasked with leading the HRO rollout.

I quickly realized the enormity of the challenge. My job was to organize training for over 5,000 people and manage the components of a patient safety program. It felt like our organization had decided to transform from a neighborhood bistro into a Michelin five-star restaurant with just a single four-hour class. They had hired me as the executive chef without even checking if I could cook.

Over the next few years, I immersed myself in high-reliability. I read books, learned the history, and shared emotional moments with colleagues and patients over stories of errors and preventable harm. We followed the science, adopted best practices, and initially saw incredible results. Organizations from across the country reached out to learn from our success.

However, as time passed, we hit a plateau. The initial excitement and momentum waned, and I sensed a fragility in our work. Despite having the best ingredients (leaders, staff, and physicians) and the right recipes (science-backed best practices), something was missing.

 A couple years later, a conversation with a friend, a culinary arts faculty member, provided the missing piece. When asked about his goals for the academic year, he said, “I want my students to have a relationship with the food they prepare.” That’s when it hit me; the secret ingredient we were missing was a relationship with the systems.

In high -reliability, systems are described as either complicated or complex. In complicated systems, relationships among parts are predictable. But in complex systems, like healthcare, relationships are unpredictable. Each patient’s journey is unique, and outcomes cannot be guaranteed by merely optimizing processes and resources.

High-reliability is a noun, something that can be documented and measured. High-reliability organizing is a verb, the action taken to achieve reliability. It involves cultivating a relationship with the systems we work within.

To truly achieve zero preventable harm, we must interact with our systems differently. For example, valuing the time spent in huddles not as a formality but as an opportunity to deeply understand our team members’ experiences. This shift in perspective changes how we listen and connect with each other.

High-reliability organizing requires leading with and nurturing strong relationships among people and systems. By asking different questions and seeking diverse perspectives, we can generate innovative ideas and solutions.

If you want to transform your relationship with your systems, take a deep breath and, as my friend Marci says, “pull your courage out of your pocket.” Reexamine how you engage with the people, processes, and systems around you, and embrace this new approach on your journey towards high-reliability.

Conclusion

High-Reliability Organizing is more than just following best practices; it's about creating a relationship with the systems and people involved. By shifting our perspective and valuing these relationships, we can drive meaningful change and truly achieve zero preventable harm in healthcare.

 By embracing this new mindset, we can move beyond surface-level changes and create lasting, impactful improvements in patient safety and care quality. Let's embark on this journey together and make a real difference.

Share Your Thoughts

What are your experiences with High-Reliability Organizing? Have you found ways to foster better relationships within your systems? Share your stories and join the conversation!