In the midst of an unprecedented "change management experience," the AHA's top quality executive wants leaders to take a page from other industries that must successfully manage high-risk processes.
Hospitals nationwide are enduring an unprecedented "change management experience," says Jay Bhatt, DO, who took charge of several of the American Hospital Association's quality efforts this summer, including the AHA's Health Research and Educational Trust.
Bhatt recommends that healthcare leadership take lessons from other industries that must manage change to avoid major harm or catastrophes.
He champions "high reliability" to improve safety at hospitals. High reliability is the technique of standardizing high-risk processes, and is used in nuclear power, aviation, and other industries where errors can have disastrous consequences.
Some organizations—including Medstar Health in the Washington, DC area and Advocate Health Care in Chicago—are moving toward higher reliability, says Bhatt.
"There are hospitals in which there over 900,000 blood transfusions without a mismatch, or three years without a catheter-based infection, or a million prescriptions without an error," he says.
In high-reliability hospitals, staff members are "sensitive to operations," he says. "Leadership is aware of how different processes and systems effect the organization… Each member of the staff is really thinking about those operations."
That creates an internal learning system that produces real-time feedback on what is working and what isn't. That involves leveraging the best evidence and learning instead of assuming, he says.
"Problems are complicated, and sometimes we want to jump to easy answers," Bhatt says. "But I like to step back off the dance floor and onto the balcony to see what is happening on the dance floor."
Setting Quality Priorities
The goal is to look at an organization's systems, issues, and patterns, identify what needs to change, then "dance" in a different way to achieve a different outcome, he says.
In addition to high reliability, the AHA has several other quality priorities, says Bhatt, who sees health disparities as a quality issue. He wants to ensure hospitals that serve complex patients in low-income communities are not penalized when it comes to quality measurement.
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He acknowledges, however, that it is a complicated problem that may take some time to resolve. "It's an issue that is so important, that we want to make sure that we are doing it in a way that is most appropriate," he says.
"We haven't been able to think in concrete ways about metrics of socio-economic conditions in the same way we have be able to in other quality measurement areas. I don't know that we have had the data to be able to help us measure it until recently."
As more organizations capture and analyze data, and as it accumulates, it will be easier to incorporate this information into quality measures, he says.
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Much of this comes back to change management. "Change comes with pain and loss, so part of the work is to say, 'How do we help folks tolerate the loss they are going to feel as a result of change?' "
Hospitals can start by encouraging leadership teams to share differing perspectives on issues. Timing is also important. "Helping manage that loss at a pace they can tolerate helps manage the change," he says.
Leaders can promote change more effectively if they can show staff members how the changes will save lives, improve outcomes, and lower costs.
"We need to streamline, we need to align, we need to focus, we need to partner," says Bhatt. "If we do those things, that will make a difference."
Tinker Ready is a contributing writer at HealthLeaders Media.