May 2023 HRO Theme of the Month is aligned to the HRO Principle “Deference to Expertise.”

“Deference To Expertise”

Dear Colleagues,

May’s HRO Theme of the month is Deference to Expertise. High Reliability Organizations (HRO) value and work to cultivate a culture that shifts authority to shared decision-making with our front-line experts. Leaders make purposeful efforts to see what you see. Front-line staff are often the first to recognize a safety issue, as well as the first to develop a solution. Your input makes our Veterans safer.

The fact that an HRO must be open-minded rather than judgmental leads to the idea that the culture of the HRO defers to expertise. The key point, however, is that the “expert” involved is the person with hands-on knowledge of the operation at the point of a failure, not the “expertise” conferred by hierarchical authority or even “expertise” that is not at the operational point of failure. In the HRO, the expert has access to upward reporting, and there is no intimidation from authority to impede the communication. The openness required for the HRO to succeed depends on accurate information from every source.

These are some of the ways we invite and promote participation seeking input from our frontline staff:

Root Cause Analysis (RCA): This is a process that looks at what happened, how did it happen, and why did it happen. An effective RCA uses Subject Matter Experts (SMEs) to help answer those questions and dig down to the root cause. Utilizing SMEs is an example of Deference to Expertise.

Healthcare Failure Mode and Effects Analysis (HFMEA): This process looks for potential hazards or points of failure before they occur and works to develop/implement solutions to prevent any harm from reaching the patient. HFMEA teams are made up of frontline staff, with each participant an expert in their area. By looking to the staff that do the work, we can see a more complete picture of the process and workflow.

Lean Six Sigma Projects: Lean Six Sigma Projects are meant to assist with and promote Continuous Process Improvement. An integral part of each project is customer/stakeholder involvement. These are often staff from multiple areas of our operations. Again, we need frontline experts to ensure we are mapping the actual process as it is occurring. Without frontline participation, the project team would only be guessing at processes, areas needing improvement, and possible solutions.

HROs appreciate that individuals can develop exceptional knowledge or expertise in their work and emphasize expertise over hierarchy. The next time your leader reaches out for staff to participate in a project, RCA, HFMEA, or any other improvement event, I challenge you to participate. This is your opportunity to share your expertise.

Deferring to Expertise in a High-Reliability Laboratory

Link to Article: Deferring to Expertise in a High-Reliability Laboratory

• Key Takeaways:
• Article addresses important aspects of the High Reliability principle of Deference to Expertise and the impact on Laboratory operations, emergency situations and Lab quality improvement efforts.
• Read time: ~ 15 minutes

DAVID ISAACKS, FACHE