Caveats for high reliability in healthcare

Abstract

Purpose Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice. Design/methodology/approach Classic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care. Findings Highly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care. Research limitations/implications Dramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families. Practical implications As healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities. Originality/value This paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends.

Improving long-term care services: insights from high-reliability organizations

“…Third, our study contributes to the HRO literature in health care as well. Previous research on HROs raises the importance of a multilevel assessment of reliability in health care (Martelli et al , 2018). By weaving all influential levels of reliability in the LTC industry, all the way from the top of the hierarchy to the frontline individuals, ours is among a handful of studies (such as Sutcliffe et al , 2016) that assess reliability across the boundaries of a system.…”

“…However, the fact that LTC homes are categorized as complex adaptive systems (Anderson et al , 2003) makes pinpointing a single cause of failure, like privatization, an overly simplistic and possibly misleading conclusion. We follow the recommendations of Martelli et al (2018), who advocate for examining the reliability of a health-care delivery system not in isolation, but rather inter-organizationally across system boundaries. Toward this end, we adopt a bird’s-eye view to analyze the current state of reliability of the LTC industry and propose theory- and evidence-informed approaches for actions at the regulatory/government, management/investor, operational, team and individual levels.…”

Leadership for reducing medical errors via organizational culture: a literature review

“…While high reliability has been successful in other industries, health care has not seen uniform results. There is little foundational research on high reliability in health care; health care “differs in consequential ways from other industries viewed through the (high reliability) lens” (Martelli et al , 2018). Could the difference in success be more attributable to leadership than to a specific intervention?…”

Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis

“…Positive, self-reinforcing team-based models of care prove critical in environments with dynamic staffing (Gittell, 2016; Martelli et al, 2018; Pronovost et al, 2006). In this study, sustained improvements reflect promisingly on the sustainability of SIBR implementation and potential for scale-up.…”

“…In this study, our academic–practice partnership collaboratively adapted and implemented interprofessional team training, leadership workshops, and SIBR processes (our intervention) in an inpatient advanced heart failure setting, with the goal of improving the quality and reliability of communication, relationships, and efficiencies (Abu-Rish Blakeney et al, 2019; Martelli et al, 2018; Willgerodt et al, 2019). Prior to SIBR implementation, coordination of care occurred through multiple steps each day, including team rounds in a designated office space and/or outside the patient’s room (in the hallway) followed by patient assessment at the bedside.…”