Dave Gans thinks every physician group needs to be an HRO—a high-reliability organization. HROs handle emergencies well because they recognize danger signals and respond in such a way that their systems continue to function and catastrophic outcomes are avoided.
Gans, the vice president for innovation and research for the Medical Group Management Association, talked about HROs at the MGMA annual conference in Las Vegas. He had a lot of hard questions for the physician audience, including:
- Have you thought honestly about the high likelihood of a life-threatening occurrence at your office?
- Who will lead the response?
- Does your staff know what to do?
HROs are transparent, Gans says. “They are always looking for the unexpected. They have a system in place and everyone knows their job.” He adds that too many physician practices operate on a need-to-know basis, which can leave staff out in the cold when an emergency arises or something out of the ordinary occurs in the practice.
The HRO concept comes from studies of risky operations, including aircraft carriers, the U.S. air traffic control system, and nuclear power plants, that avoid catastrophe because they prepare for it. HROs are found in a lot of industries, and they’ve usually earned their HRO stripes the hard way: through tragedy or crisis. Gans says physician practices don’t need to go through those trials—they can learn from the experiences of other organizations. HROs like NASA and the commercial aviation industry involve complex activities with many people involved. A space launch, for instance, requires the coordination of millions of pieces of information and hundreds of people who know exactly what they need to be doing at any instant.
What does a physician practice have to gain by being an HRO? There’s not a plaque or a framed certificate that identifies an HRO. Gans says that for a medical group, operating as a highly reliable organization means it’s ready to deal with the unexpected. Staff roles and responsibilities are clearly defined, decision-making is deferred to the most knowledgeable person on the team regardless of their position in the hierarchy, and a high degree of accountability develops among the office and professional staff. “It becomes everyone’s job to look at the big picture and identify potential problem areas in a physician practice. Everyone is involved in identifying small problems that need to be resolved before they become worst-case scenarios,” Gans says.
One common stumbling block for physician groups developing an HRO—and for many organizations—is accepting the inevitability of human error. “We don’t always like to hear about mistakes, but successful HROs are preoccupied with failure. They want to know what went wrong and what steps can be taken to avoid that situation in the future,” Gans says.
Physician practices building toward HRO status can encourage error reporting and even develop reward programs around reporting errors as a way to enhance reliability.
The bottom line for physician group HROs is that they often see improved financial results, Gans says. “They are able to work faster, smarter, and see more patients”—with the confidence that when the crisis comes, they will be ready.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
