Transforming into a high reliability organization in health care

The US health care system's long-held FFS payment model reimburses professionals based on a narrow set of regulatory or reimbursement incentives for discrete activities, such as a doctor's visit, with no compensation for coordination across the care continuum. This payment system encourages delivery of high cost/high margin services and discourages delivery of lower margin services or coordination of care. These incentives can lead to rising costs as well as inefficient delivery and potentially poor quality of care, such as adverse events, medical errors, and infections, among others. In the FFS model, since physicians and hospitals are rewarded based on the volume of patients treated rather than outcomes, there is minimal incentive to maximize patient outcomes or contain costs.

In an effort to address this issue, the US health care system is currently undergoing a fundamental shift in its business model, moving from volume- to value-based care (VBC) with a focus on quality and outcomes. Many VBC incentives and penalties rely on quality measures. Thus, delivering quality health care consistently and reliably will be key to succeeding in a value-based environment.

Despite financial, clinical, and technology drivers – and dedicated efforts at many levels – the health care industry generally struggles to achieve widespread, consistent quality improvement. As noted by Mark Chassin, President of The Joint Commission, “It's clear that we've made progress in a number of areas, in reducing healthcare-associated infections, for example. But we still have very serious quality problems, partly because the goal posts keep moving… what constituted high quality 10 years ago is not the same as what constitutes high quality today. It's a constant state of activity to increase safety and quality.”¹

One answer to providing consistent, widespread quality in health care already exists in other industries: Become a high reliability organization (HRO).

HROs are entities which are exceptionally consistent at:

• Accomplishing their goals
• Avoiding potentially catastrophic errors in an environment where normal accidents can be expected due to risk factors and complexity
• Delivering consistently safe and high-quality service

Over the past 20 years, increasing numbers of health care provider organizations have started the journey toward becoming an HRO that delivers quality care effectively, efficiently, and predictably. For many, though, the destination remains far ahead. Although it may take considerable time and effort to get there, this paper lays out a path for health care organizations that wish to embark on the journey.

Explore critical success factors, a case study, and smart first steps in: Transforming into a high reliability organization in health care.

Footnotes

1. “We still have very serious quality problems.” Modern Healthcare, January 9, 2016. http://www.modernhealthcare.com/article/20160109/MAGAZINE/301099952.