The Future of Digital Healthcare was recently the focus of a McKinsey & Co. seminar in Dubai. TeleTracking President, Michael Gallup, shared his insights as part of a panel discussion on the topic of Revolutionizing the Way Healthcare is Delivered. Highlights from this seminar and panel discussion are outlined below.
TeleTracking is committed to supporting the compassionate caregivers who dedicate their lives to improving patient care—and that’s why it is important that we create organizations and systems that facilitate safe, high quality care delivery. To this end, healthcare leaders have looked to other industries such as manufacturing, aviation and hospitality for best practice process methodologies and adopted such successful concepts as Lean and Six Sigma to drive efficiency and quality in healthcare. High Reliability Organizations (HRO) is one such concept, which is applied in high-risk environments such as nuclear power operations, naval aircraft carriers, and wildfire operations environments—places where a simple mistake could prove catastrophic. Healthcare also fits into this group.
In the context of high-risk environments such as healthcare, HROs are defined as organizations that have fewer than normal numbers accidents. These outcomes are achieved by driving systematic culture change through a combination of technology and leadership that fosters an environment of psychological safety. In this atmosphere every team member is empowered to speak up, and act in the interest of preventing adverse outcomes for patients.
In order to transform healthcare organizations into High Reliability Organizations, there are five foundational elements. The HRO framework takes an organizational mind set, and is not just a checklist.
Sensitivity to Operations: The purpose of healthcare operations management, and the supporting technology, is driving, coordinating, and automating all the operational workflows that ultimately enable the caregiver-patient encounter. In order for patients to receive high quality, safe care anywhere across the healthcare continuum, it is important for caregivers to be focused on care delivery—not getting distracted by operational tasks such as cleaning patient beds, locating beds for patient placement, locating mobile medical equipment, etc. These tasks could take up to 20% of a nurse’s time on any given day—at the expense of time that they could be spending with patients.
Reluctance to Simplify: Successful leaders routinely practice evidence-based management, grounding their decisions in facts and accurate data, as opposed to anecdotes and opinions. Spending on clinical and non-clinical staff is typically 55%-60% of operating expense for most hospitals. Therefore, it is critical to make sure that managers plan nursing staff time with a high degree of precision.
Preoccupation with Failure: HROs strive to design their organizations in a manner where there are minimal possibilities for errors, or near misses, to creep in. A great healthcare example is the inadvertent spread of infections from one patient to other patients or staff members. It is estimated that hospital acquired infections cost U.S. hospitals $36 to $45 billion annually. Well run organizations rely on technologies to make sure the isolation status of patients is prominently marked in the system for those infected with diseases like C.Diff or MRSA.
Deference to Expertise: Healthcare management and patient safety literature extensively covers the need to promote a culture of teamwork and psychological safety so that nurses and residents feel comfortable to speak up if they notice a patient safety issue. It is critical to foster such a culture in extremely hierarchical situations, such as operating rooms, where surgeons must rely on observations made by other front-line team members who may spot potentially fatal errors or issues.
Resilience: HROs are designed to minimize errors. However, it would be shortsighted to assume that the system is 100% error proof. The hallmark of HROs is that when setbacks do happen, the response and recovery is prompt. Keeping with the previously discussed example of hospital-acquired infections: Royal Wolverhampton NHS Trust in the United Kingdom has the world’s largest deployment of RTLS (real-time locating system) enabled healthcare operations. This means they tag every patient, staff, bed, and piece of equipment, which allows them to run interaction reporting. That means if an infection breaks out they can move swiftly by running audits on interactions between infected patients and resources in order to implement the necessary infection control protocols.
The High Reliability Organization mindset has made a significant impact in other high-risk environments such as nuclear power operations. Healthcare organizations now have access to sophisticated tools that allow the leadership to transform their organizational culture and build systems that enable high quality, safe patient care.
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