What is an HRO?

A High-Reliability Organization (HRO) in healthcare is an organization that prioritizes safety and strives for zero preventable errors or harm to patients. Sounds easy right? This approach to patient care is based on the concept of “high-reliability” as it has been developed and applied in other industries, such as aviation and nuclear power.

In a healthcare HRO, processes and systems are designed to minimize the likelihood of errors and to quickly detect and correct any errors that do occur. The goal is to create a culture of safety where everyone is responsible for preventing harm and where continuous improvement is valued and encouraged.

But how do we accomplish this as an organization?

Strong leadership: To move the needle on the process toward an HRO we have to start at the top. Leaders in an HRO are committed to patient safety and continuously work to improve processes and systems. This work involves multiple principles of change management, effective communication and a "you said we did" mentality.

Clear and effective communication: Open and effective communication is crucial in an HRO, as it helps to ensure that everyone is aware of potential hazards and that errors are quickly identified and corrected. There must be an easy and effective way to bring issues from the frontline to leadership so that potential risks can be mitigated quickly. Think of tiered systems to address these concerns.

Defined processes and protocols: Clear and well-defined processes and protocols help to minimize the likelihood of errors and ensure consistent, high-quality care for patients. When we have variability in our processes or lack a clear understanding of what is to be done and when, we open ourselves to a plethora of risks.

Continuous monitoring and improvement: In an HRO, processes and systems are continuously monitored and improved to ensure that patient safety is maintained. As we progress as an organization we have to review what and how we are accomplishing our work from the frontline to the top. If we are being ineffective or are variable in our processes we have to continuously focus on improving them. That's where the term continuous process improvement comes from.

Teamwork: Teamwork is essential in an HRO, as it allows individuals to work together to identify and address potential hazards and to improve processes and systems. We have to break down silos. If nurses feel that they are on a different team than the doctors or social workers they work with daily we will see, not only reduced communication but ineffective communication. In healthcare, this leads to errors and errors lead to poor patient outcomes.

Empowerment: In an HRO, all staff are empowered to speak up and take action when they identify potential hazards or errors, and to continuously improve processes and systems. This goes directly back to the communication piece discussed earlier. If a staff member sees something they must be empowered to bring this issue to the highest level of an organization if they feel it's necessary.

Focus on learning: An HRO is committed to continuous learning and improvement, and recognizes that errors can provide valuable opportunities for learning and improvement. As with all learning and education, this must come with a plan. If we train employee X in training Z, what expected outcome do we want to see out of this and how will it help the employee help the organization? As a side note, how can we measure it?

The ultimate goal of an HRO in healthcare is to provide safe, high-quality care for patients and to continuously improve processes and systems to minimize the likelihood of preventable errors and harm. The above examples are just a few of the intricate pieces of developing into an HRO. We must empower employees, be present in our organizations and above all, listen.