Leadership “Hardware” and “Software”: Two Critical Components of a High-Reliability Organization

by Ronnie Daughtry

Vizient Associate Principal, Reliability & Management Systems

In a recent blog post, my colleague Bradley Schultz discussed how management systems provide the infrastructure for executing organizational strategy, sustaining improvements and creating a heightened state of staff engagement during the high reliability journey. Indeed, the management system is an essential component that supports the high-reliability health care organization (HRO) infrastructure. Just as gray matter in the central nervous system enables an individual to control memory, movement and emotions, leadership enables the organization to move in the right direction, operate in the right environment and set the foundation for improvement, all of which help to create and sustain high reliability in health care.

How do health care leaders achieve high reliability? Is there a leadership pill that can be taken that will help address complex organizational challenges and lead to reduced harm? Is there a training course available that can guarantee to become a high-reliability organization? Unfortunately, it is not that easy. In fact, the process can be painful and involves behavior transformation and a lifelong commitment to learning.

While it is still a bit of a mystery how health care HRO leaders produce the results that they do, their attributes and behaviors appear to fall neatly into a couple of categories. The first category is what I refer to as “hardware,” while the second one, “software,” builds on the first.

Leadership hardware

Think of high-reliability organization leadership “hardware” as tactical tools that can be observed. There are many tactical tools, but the essential components include:

• Organizational stability (facilities and staffing)
• Management system (transparency, accountability, problem-solving, continual improvement and strategy deployment)
• Organizational continual learning

Organizational stability is essential to health care HROs. Today, the health care industry is more challenged in this arena than ever before. The pandemic coupled with the number of caregivers leaving the industry versus the number of those entering the field elevates the challenge to create stability. However, stability is enabled when organizations have the required resources to meet patient demand and the right facility capabilities to match. In order to achieve high-quality outcomes and patient satisfaction, the basic requirements of the system must be met. For example, if 50 people are in line at a grocery store and there is only one cashier to staff only one of the 15 available registers, then customers will wait and most likely be unhappy. Several might even abandon their shopping carts and leave without checking out. By the same token, a health care leader must ensure that there is enough staffing to serve patients as well as enough physical capacity in all areas to serve demand. While there are no silver bullets to fully meet staffing requirements in many cases. We are currently experimenting with care models and other means of distributed work to meet the demand. In short, the high-reliability organization leader is responsible for driving the solutions and ensuring the requirements for stability are in place.

Management systems are observable if they are in place. We can observe standard work, visual management, leader standard work and the coaching that leaders do. Management systems help to execute the organizational strategy and continually improve all processes that support the strategy. Ultimately, management systems are the tactical means used to produce organizational resilience. Leader coaching at each layer of the organization is a key tactical tool that supports learning and mindfulness across the organization.

Organizational continual learning does not occur by accident. It is pragmatic, tactical, intentional and purposeful. Coaching tied to the management system is critical and a key vehicle to learning that occurs daily along the pathway. High-reliability organization leaders encourage staff to further and develop their abilities and they foster the environment for self-awareness and learning across the organization. In turn, leaders are not exempt from these activities; in fact, they not only initiate them but are first in line to be coached.

Leadership software

High reliability organization leadership “software” is a core set of cultural and workplace environmental factors that produce purposeful behaviors fundamental to the high-reliability organization philosophy. These tenets center around the ideas that humans desire to do a good job (respect for people) and they are also fallible (non-blaming, nonjudgmental environments that function with accountability).

High-reliability organization leaders share the belief and do not automatically assume that people show up to work each day planning to do the bare minimum, or that most would sabotage the organization if given the opportunity. These are considered rare exceptions and not typical behaviors. Dr. William Edwards Deming, an American engineer and author, wrote extensively about this subject and stated that, “… the job of the leader [is] to restore the worker’s pride and joy in work.” High-reliability organization leaders work on the system, not within it, and they respect the people and their contributions and expertise that they bring to all levels of the organization.

Despite our best efforts to adhere to well-designed processes and procedures, employees are human beings and are imperfect. Great leaders understand this fact and create environments that do not place blame. They look at the system, the process and the data to understand what contributed to the failure and then they collectively address the issue to prevent it from happening again.

Leading a high-reliability organization is dynamic … and tough! It is as much and perhaps more about personal change and behavior modification than it is about organizational behavior change. It begins with self-awareness and continues with the willingness to be coached along the journey.
Earlier this year, Vizient announced the launch of its high reliability organization solution for sustained delivery of safe health care. Additional information is available online.