Leadership Role in High Reliability Organizations

Leadership is at the pinnacle of the HRO framework. The CEO is responsible for launching the critical first step of establishing safety as the most important part of what everyone does, every day. The primary function of leaders in health care is to influence their followers to develop behaviors, habits, processes and technologies that result in the safest places to give and receive care. In an HRO, leaders are not identified by position or rank; they exist at all levels and in all groups. The HRO framework requires that all formal and informal leaders are committed to achieving safe, reliable and effective operational excellence. Leaders should take ownership for setting the climate and focusing the work. Essentially, leaders have four main responsibilities in HRO development.

• Guard the learning system. Fully engage in the work of self-reflection that leads to comfortable, nonpunitive transparency; understand and apply improvement science, reliability science and continuous learning; and inspire such work throughout the organization
• Create psychological safety. Ensure that anyone in the organization, including patients and families, can comfortably voice concerns, suggestions and ideas for change.
• Foster trust. Create an environment of nonnegotiable respect – ensure that people feel their opinions are valued and any negative or abusive behavior is swiftly addressed.
• Ensure value alignment. Apply organizational values to every decision made, whether in service of safety, timeliness, effectiveness, efficiency, equity or patient-centeredness.

When leaders consistently deliver on these responsibilities, they set the stage for a culture and learning system centered on safety and reliability.

Leaders also should be accessible and consistently round on patients and front-line staff. Communication must exist in organizations that link the leaders’ responses to front-line provider concerns to ensure that staff feel their voices are heard.

Resources:

• Eliminating Harm, Improving Patient Care: A Trustee Guide
• A CEO’s Perspective Podcast
• TeamSTEPPS Readiness Assessment
• Agency for Healthcare Research and Quality Culture Survey
• Leader Rounding Scouting Report
• Culture of Safety Change Package
• IHI Framework for Safe, Reliable and Effective Care
• ACHE Leading a Culture of Safety: A Blueprint for Success
  • Creating and Sustaining a Culture of Safety
• Practical Applications of High Reliability Principles in Health Care

Become a High Reliability Organization