Under HCRO, there are two words and definitions we often use to describe attributes of reliable systems:
- Effective – successful in producing a desired or intended result, and
- Resilient – able to withstand or recover quickly from difficult conditions
In socio-technical systems (i.e., systems relying on human input or management), reliability requires that both efficacy and resiliency be given equal focus.
At the time Henry Ford introduced the world’s first mass-produced automobile, the initial goal was to provide a more effective, affordable, and convenient mode of transportation. Compared to horse-drawn carriages and steam locomotives, Model T’s were proven to be much more effective at transporting humans from A to B than other land-based modes of conveyance. But along the way, resiliency became an important consideration as cars increased in popularity.
Reliability (i.e., efficacy plus resiliency) became a critical purchasing factor for consumers – not just in how often the car would start and run when called upon – but also how safe and resilient the cars were when things went wrong. Over several decades of improvement, rudimentary features such as horns, windshield wipers, turn signals and seat belts evolved into more advanced features such as anti-lock brakes, air bags, adaptive cruise control, and back-up cameras. And of course today, the rapid advancement of autonomous vehicles is expected to systematically reduce (and virtually eliminate) the human contribution to automobile accidents.
Resiliency in Socio-Technical Systems
Think of resiliency as the ability to recover from two types of failure modes:
- Systems (e.g., processes, software, or hardware), and
- People operating in the system (human choices and errors)
The phrase “error-tolerant design” is commonly used to describe resilient systems (e.g., think of the gas pump where a check valve automatically drops into place, preventing fuel from spilling out of the pump whenever a driver fails to remove the pump handle after fueling a vehicle).
But human error is only one way in which people fail to perform. The far greater everyday risk lies in the choices we make, including at-risk and reckless choices. Resilient systems have the capacity to take both system and human failures into account and prevent harm through “adaptive design.”
The Need for Greater Resiliency in Healthcare Systems
As successful healthcare professionals and organizations, the outcomes we produce are a product of not just our medical expertise, but also our ability to deliver this expertise in both effective and resilient ways. We must extend our vision beyond the traditional modes and methods of delivery. Because healthcare is a socio-technical enterprise, our focus on reliability must look beyond the effectiveness of our software, hardware, and process-driven systems. We must think in terms of resiliency, and embrace predictive approaches to managing our socio-technical outcomes. Improving the tools we use to deliver care across the spectrum of healthcare – from electronic records to patient identification to diagnostic and surgical devices to medication administration and beyond – requires a more complete understanding of the socio-technical science and a relentless focus on reliability.
Our HCRO Approach
Our HCRO approach provides the strategies and tools needed to fulfill this vision. Based on the socio-technical science, our Framework for Reliability guides us to a sequenced approach to managing risk, working our way from seeing and understanding risk, to improving systems and managing behaviors, to building organizational sustainability. In our next article, we’ll examine ways in which we can manage behaviors in more effective ways, distinguishing between human errors and behavioral choices.