Leading in a High Reliability Organization
High Reliability is NOT just a list of patient safety tools and processes. It provides people on the front lines the power to drive change. Leaders and front-line staff need to constantly learn, together. This means that leaders need to develop the skills to create, and sustain, this type of culture.
Many organizations have been on their HRO journey for several years but are still struggling to create a true “high reliability culture.” When we see this issue we tend to focus, not on replicating training on HRO tools and processes, but on teaching physicians and administrators how to LEAD in a high reliability organization
Too Often, the Huddle Becomes Nothing More than a Report-Out
A great example: The Huddle – Its primary purpose is to exchange information at each shift change. But – it’s also a perfect opportunity to model psychological safety! Unfortunately, over time, huddles often turn into simple “report-out” meetings, and leaders are NOT taking advantage of this learning opportunity.
Most leaders have been trained on the concept of psychological safety, but they don’t always appreciate it as central to HRO culture. And if they do, they don’t always model it or reinforce it. This is a missed opportunity.
We encourage leaders to:
- Remind the team of the huddle’s purpose.
- Use EVERY huddle as an opportunity to learn from each other.
- Use EVERY huddle as the opportunity to model and encourage psychological safety
The Huddle Dynamic
- Be Curious
- Have an internal questioning attitude, such as, “What was happening in this situation that caused well trained, well intentioned people to make the choices they made?”
- Focus on attacking the problem, NOT the person
- Challenge ideas and propose new ideas – and encourage people to challenge THOSE ideas. This is the only way that safety can be actively created, and adverse events avoided.
- Be empathetic – Remember the team members involved can also be harmed. Remember that they have their own fears, anxieties and concerns. Make sure they know they are valued, that their ideas are valued, and that errors are usually about process, and provide opportunities for improvement.
Remind People (and Yourself) what Psychological Safety Really Means . . .
- Anyone can ask for feedback without being judged.
- Anyone can challenge an idea (professionally and respectfully).
- Anyone can ask a question or ask for help without others taking it as a sign of weakness or incompetence; and
- Anyone can suggest new ideas/innovations without being considered disruptive.
People forget that team dynamics, and the ability to communicate openly and effectively are FAR more important than the HRO tools and processes. The latter are important. The former are critical.