Failure is a Dirty Word in Healthcare - 3 Actions You Can Take to Facilitate Excellence

Failure is a Dirty Word in Healthcare - 3 Actions You Can Take to Facilitate Excellence

What will be your next step toward capability building?

Failure is a dirty word in healthcare, but it’s a reality. 

When a process, system, or function fails to perform as expected without error over time - you have failures and unreliability. We like to call them mishaps, challenges, opportunities for improvement (OFIs), issues, but other industries call them for what they are - failures. 

Most processes in healthcare function at an average of 80% or less reliability (Resar, 2006).

• That means about 2 in every 10 process events fails to be completed without error
• In reliability language, less than 80% reliability is generally considered chaos
• When you’re averaging 80%, you have a significant number of processes that aren’t even at that level - that’s a lot of chaos and failures to perform as expected over time (unreliability).

Why does this happen?

Healthcare has created an environment and infrastructure that inhibits reliability through (Carver et al, 2020; Rasmussen and Vicente, 1989; Resar, 2006; Senge, 2006):

• Faulty processes, systems, and conditions
• Human error
• Dependence on vigilance and hard work for improvement
• Reliance on mediocre benchmarks creating a false sense of reliable performance
• Process designs that rarely have articulated reliability goals
• Facilitation of wide variation in practice because of permissive attitudes toward autonomy
• Reliance on perception or biases to assess reality vs. objective observations and commitment to truth about system performance

Healthcare is also an environment high in variability and unpredictability, changing team members, varying social status and power, and different ways of communicating all of which add to complexity (Blatt, et al, 2006).

Not to mention that healthcare clinicians, physicians, and clinical leaders are largely untrained in business management practices, including building reliability (Taylor et al, 2013). That means these highly skilled people don’t have the tools to make changes they often recognize as needed. 

What is needed to fix it?

To address reliability problems in healthcare, we need to build internal capability into the people who do the work to effectively recognize failure points, design and improve new or better processes, and commit to changes (Taylor, 2013; Chassin & Loeb, 2013).

Building reliability requires:

1. Education about robust performance improvement methods to build internal capability.
2. Engagement of leaders and employees through development practices designed to increase commitment and collaboration.
3. Empowerment of the people who do the work to change the work through culture optimization. Reliability cannot take a foothold without a culture that supports it.

What actions can you take?

Tap into the incredible passion, intellect, and innovation that exists within your organization - the people who are dedicated to getting healthcare right. 

1. Give them the tools and the flexibility to effect change where they interact in the system daily. 
2. Get commitment from formal and informal leaders to objectively evaluate system performance and pursue improvements. 
3. Optimize your culture to facilitate learning, innovation, trust, and accountability in order to pursue and sustain meaningful change.

It is possible to create reliable systems in healthcare. A choice to build internal capability is a right first step.

References:

• Blatt, R., Christianson, M. K., Sutcliffe, K. M., & Rosenthal, M. M. (2006). A sensemaking lens on reliability. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 27(7), 897-917.
• Carver, N., Gupta, V., & Hipskind, J. E. (2020). Medical error. StatPearls [Internet].
• Chassin, M. R., & Loeb, J. M. (2013). High‐reliability health care: getting there from here. The Milbank Quarterly, 91(3), 459-490.
• Rasmussen, J., & Vicente, K. J. (1989). Coping with human errors through system design: implications for ecological interface design. International Journal of Man-Machine Studies, 31(5), 517-534.
• Resar, R. K. (2006). Making noncatastrophic health care processes reliable: learning to walk before running in creating high‐reliability organizations. Health services research, 41(4p2), 1677-1689.
• Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. New York : Currency.
• Taylor, E., Genevro, J., Peikes, D.N., Geonnotti, K., Wang, W., & Meyers, D. (2013). Building Quality Improvement Capacity in Primary Care: Supports and Resources. Mathematica Policy Research Reports.

Photo Credits:

• 1+1=3: George Becker on Pexels
• Chaos: Cottonbro on Pexels
• Pyramid: Copyright 3 SEES, LLC