There’s no doubt that healthcare is an industry resilient to change. Organizations in healthcare are constantly adapting to an industry in flux, whether it’s changing trends in the health of patients, tighter budgets or increasing digitization.
However, in healthcare risk management, “resiliency” means more than weathering change. It’s about moving to a proactive focus on error recovery, rather than a reactive approach to errors themselves.
The fundamentals of institutional resilience
Resilience in risk management is considered on two levels: personal and organizational. In this post, we’ll focus on organizational level resilience.
According to an NCBI article, organizational resilience refers to “the ability, within complex and high-risk organizations, to understand how failure is avoided and how success is obtained. It describes how people learn and adapt to create safety in settings that are fraught with gaps, hazards, trade-offs and multiple goals.”
In some respects, resilience bears similarity to another popular risk management trend in healthcare: high reliability organizations (HROs). However, while there is considerable overlap, resilience is more fluid concept that effectively focuses on how things are done right in healthcare so that teams can proactively work to make sure that things don’t go wrong.
Resilience, like all change, is a process. Research on resilience in healthcare defines three broad stages that most organizations move through during their resiliency journey: reactive, interactive and proactive.
In the first stage, the organization is focusing on improvement, but through the lens of errors. From that process, insights are gained into how errors can be avoided. Responses at this stage are brittle – meaning that when problems do arise, organizations are not prepared to adapt to address them. In the second stage, interactive, there’s a hybrid focus on errors and successes.
In the final stage, proactive, organizations are focusing on what they are doing right. By placing a focus on these insights, they can replicate successful practices throughout the organization, effectively instilling best practices to ensure that mistakes don’t happen. Reaching the proactive thinking toward the future, critically assessing what risks could lead to an error and working to eliminate those risks before they happen.
Reaching the third stage doesn’t mean ignoring the bad – resilient organizations still value investigations into the root causes of adverse events and other errors when they do happen. Rather, the focus is on being proactive, spreading best practices that are working will to mitigate risk and thinking critically about what risks could be on the horizon.
If you build positivity, they will come
When discussing risk resilience, a secondary conversation tends to arise about the impact of positive approaches to risk management and error recovery. Not only do resilient organizations spread successful practices throughout the organization, they encourage engagement. While this may seem like a happy side-effect, creating an environment that celebrates the positive and focuses on prevention is critical in ensuring staff buy-in to risk management strategies.
The critical nature of buy-in and engagement is not new. In 2008, a report by the World Health Organization states that “relying on the blame approach alone is likely to drive problems underground and impede an honest and effective strategy to improve patient safety.”
Indeed, building trust remains a key challenge in engaging staff and building a culture of safety. Practices like reporting near misses and good catches, and conducting RCAs on a diverse array of incidents (not just sentinel events) are one way that healthcare organizations are shifting the onus away from “blame.”
Jessica Behrhorst, System Director of Quality and Patient Safety at Ochsner Health System, found that changing the organization's framework for conducting root cause analyses transformed how staff felt about the process. “We’d have people who would call in sick because they didn’t want to participate in an RCA meeting,” says Behrhorst. Moving to the RCA2 framework changed staff perspectives by taking the focus off individual culpability and focusing on process improvement and error recovery.
From the bottom to the top
To be effective, resiliency must be an all-hands-on-deck pursuit. That means engaging healthcare professionals at multiple levels of the organization.
There are three interconnected levels of resiliency:
A commitment to resilience at the individual level means being outspoken about safety concerns and risks at your organization and engaging proactively with tools and strategies that are in place. At the micro-organizational level, commitments to resilience may include leadership engagement, clear channels of communication and closing feedback loops. Finally, a macro-organizational commitment to resilience consists of a clearly articulated and well supported corporate commitment to safety.
Resiliency in healthcare can happen on many fronts – it can involve the physical design of the space, staff training and education, flexible technologies and leadership planning. When achieved on any front, however, the result is a way of thinking that effectively mitigates present risks, encourages positivity and plans ahead for what is yet to come.
Want to learn more about how Ochsner Health System transformed how staff perceived root cause analysis? Read the full article on the blog.