One of the most common questions we receive is “How do we know if our organization is ready to become an HCRO Cohort and work to become part of the HCRO Community of Practice?” Perhaps the best answer is that for any organization to commit to the hard work and resources required to become a Cohort, you must first understand the direct and indirect benefits, assess the challenges you will face, and marshal the commitment necessary to reap the rewards. Let’s examine each of these.
The Many Benefits of HCRO
One of the many benefits of embarking on the HCRO journey is aligning everyone in the organization with the scientific principles of reliability, a common vocabulary, and the organization’s values and strategy. In contrast to campaign slogans and other traditional approaches, HCRO engagement aligns everyone within the organization around a core set of values and priorities that are balanced and supported simultaneously. Safety, privacy, evidence-based practice, compassion, and fiscal stewardship are all brought into focus as priorities that must be recognized and balanced appropriately. The direct benefit of this approach is that the workforce more fully appreciates the responsibilities we have inside the healthcare organization, pulling together within a community of practice.
Along the way, applying a “systems-first” approach to managing identifiable risk leads to better understanding of human behaviors, resulting in a fairer and more consistent culture of accountability. The end result of the HCRO is “justice with purpose: producing better outcomes for all those we serve.”
The Challenges You Will Face
Any organizational leader with experience will acknowledge that culture change is difficult. In fact, it’s very likely that your HCRO journey will be the most challenging task you’ll experience in your career. Aligning departments into a common strategy, commitment of resources (finances, time, and attention) re-calibrating the words you work by, and convincing organizational leaders to embrace new strategies will not likely be an overnight success. In fact, oftentimes the most challenging aspect of change management begins with convincing successful individuals to do something different than what may have contributed to past success. After all, if I’m successful today, what would motivate me to think or act differently in the future?
The answer lies in the socio-technical science. A teenager may explain to their parents that wearing a helmet while riding a bike or skateboard is not necessary because “I’ve never hurt myself from a fall in the past.” This direct experience does not translate well into the risk of not wearing a helmet in the future. This is a societal dilemma stemming from human psychology and the biological sciences – we have evolved to perceive risk through direct, rather than predictive, experience. The good news, however, is that both teenagers and organizations can evolve further, recognizing improved strategies for both health and survival. Eventually, teenagers grow older and organizations improve.
The Commitment to Reap the Rewards
Leadership commitment to embarking on the HCRO journey requires something beyond a “leap of faith” – it requires a fundamental understanding of the socio-technical science of reliability. While many of the traditional improvement programs in the past have produced measurable improvements, many of these strategies have not yielded optimal or sustainable results. Optimizing our resources into deliverables begins with understanding and applying scientifically sound principles, and requires collaborative execution across the entire workforce. In order to achieve success, your commitment to begin the HCRO journey requires a willingness to “walk the talk” and engage with physicians and staff differently than in the past and embrace common framework of seeing and describing ever-changing risk in the workplace. It requires a new language, or “words to work by.” (For example, replacing words such as “investigation” with “analysis;” and describing human behavior more specifically as “human error, at-risk choice or reckless choice,” rather than legalistically, as “negligent” or “egregious.”) Once your journey begins, the rewards will multiply as each success becomes the engine for future improvements.
To Pre-Assess Or Not to Pre-Assess?
There is often value in baselining improvement, particularly in performance-focused industries where outcomes are the primary measures of success. Having acknowledged this, much like the Zen master who advises his pupil to “live in the moment,” the key ingredient to HCRO success lies in focusing on Risk, Systems, and Behaviors long before the probabilistic outcomes are produced. Many times the successful outcomes we produce are fraught with risky systems and behaviors that go unrecognized or unmanaged until adverse outcomes occur.
Under HCRO, our starting point is assessing the ability to see and understand risk, design and maintain resilient systems, and manage human behaviors. These measurements are often lacking in traditional baseline measurements and pre-assessments that are based on outcomes. Regardless of whether your organization chooses to conduct a pre-HCRO assessment or not, once you begin the development of your HCRO Reliability Management System™ (RMS) you will be periodically benchmarking against yourself as you continuously improve. The key point here is that baselines, audits and inspections are always limited to a time-dependent “snapshot” of your organization’s progress. HCRO provides a more meaningful system of measurement on an ongoing and systemic basis.