Healthcare HROs: 3+1 challenges stemming from digital transformation.



A high reliability organization (HRO) is an organization that operates in highly complex and high-risk environment, yet manages to experience fewer than expected adverse events. A prime example is the commercial aviation industry. In the core of a HRO lies the culture and practice of “collective mindfulness”, meaning the philosophy that all employees are aware of, actively seek and report minor problems/obstacles before they pose a threat to the safety, sustainability and trustworthiness of the entire organization/enterprise.

As we progress even further into a new era of digital health, it should not come as a surprise that new set of challenges will emerge that will shift the current models and expectations of HROs. Digital adaptation in healthcare has introduced a new level off complexity to the daily tasks of healthcare providers, has introduced new sources for potential errors and has vastly changed the dynamics of patient-physician relationship, as well as patient-healthcare system relationship. The end result is reluctance to simplify our practices, meaning to accept the fact that we will face new challenges and are bound to make errors in the process.

There could be numerous challenges into implementing the necessary strategy, but the following 3 + 1 seem critical:


1.   Lack of a clearly defined vision of digital safety. This primarily pertains to safety of data and data privacy. This will become increasingly important as we transition to interoperable EMRs/systems, as the use of tele-health applications continues to grow and as digital giants (Amazon, Google) and entities like Walmart (!) start expanding in the field of healthcare. Lack of a precedent culture of both thinking about digital data safety, as well as practicing it is one of the major initial hurdles that need to be overcome. If medical staff is not familiar with this notion, it may be hard to get them out of their comfort-zone and start adopting different behaviors, which may feel foreign to them.

2.   Lack of trust among team members and lack of trust between staff and management/leadership. This is crucial for HROs and it would still apply to digital HROs (perhaps even more so than traditional HROs). As more employees work from home, it will be critical for teams to grow on the foundations of trust both among employees as well as between employees and senior leadership. Lack of in-person interaction has already affected multiple other sectors, as leadership struggles to find sustainable ways of creating and maintaining their team identity and authenticity. Trust needs to be cultivated and earned and the leaders of each HRO are expected to take the first step.

3.   Lack of infrastructure and resources to support collective mindfulness in the digital era. This is a practical component of implementing a new culture. Infrastructure and resources are needed to safeguard privacy data, to document errors, to record actions taken to mitigate and prevent them and finally to ensure self- and team-based reflection and continuous improvement.

Plus 1: It deserves separate, dedicated mention the need to change our current notion of “expertise”. It has traditionally been perceived that expertise goes hand-in-hand with seniority in age. Digital transformation, however, is here to challenge this concept. As we increasingly adopt digital applications in healthcare, from delivery to evaluating patient experience, it should come as no surprise that younger/earlier career employees, i.e millennials, may in fact have the upper hand. Digital expertise requires understanding and experience of a novel set of concepts and principles. Millennials may feel much more comfortable using the new technology, experimenting with it, challenging and pushing its limits and generating more innovation. The transformational process of development of a HRO is long and continuous, as there are always opportunities for improvement. The above challenges should be used as a guide to stimulate us into strategically planning the way we practice healthcare. We can learn from the examples of other successful organizations of high adaptability and preemptively design our next steps to stay ahead of the game and keep up with our patient expectations.

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