Practical HRO: Optimizing Risk Management using High Reliability Organizing

This podcast is part of our HRO and Healthcare focus. The episode features Sheeva Azma, founder of Fancy Comma and a freelance science, technology, health, policy, and business journalist. Her investigative journalism introduced her to High Reliability Organizing and how it can help overcome bias, racism, and burnout in healthcare workers. Sheeva's research highlights the impact of Covid and Long Covid on patients, doctor's decisions, and burnout amongst health care staff. Improving and planning against this impact, HRO can help organizations make changes to their cultures to reduce the impact and improve the work environment.Sheeva also has a relationship with the Patient Safety Movement Foundation. This organization is focused on patient safety in a variety of healthcare settings and situations. Like Sheeva the Patient Safety Foundation is committed to Zero Harm.

In this episode we explore the need for operational risk management by startups. I'm joined by Mr. Rick Gardener, executive director of the University of Buffalo's Business and Entrepreneurship Partnerships office. Rick has experience in all types of business settings from startups to NFPs. He holds 32 patents and brings a risk management perspective to his work.When you talk about risk management for startups, Rick introduces the idea of moving from "the land of possibility" to a more firm perspective...  identifying the actual risks that are going to get in the way of bringing your product to market. This is often a challenge for founders, and may be especially applicable for tech startups.  Rick sees an additional challenge for technical startups. The bulk of their work and thinking has been technical in nature. While it's important to overcome the technical obstacles, it is equally important to understand and plan for commercialization challenges.Rick has some awesome insights and offers some best practices on dealing with risk and commercialization for startups.

Joining us in this episode is Dr. David O’Rourke, District Superintendent and CEO of Erie2 BOCES, a cooperative education service that works directly with school districts to offer needed special services for students and schools. We’re going to talk with David about managing risk in the middle of a crisis.  A crisis no one saw coming.  We look at the operational, personnel, and student risks that had to be overcome, and we’re going to get some insight into how we can use this crisis as an opportunity for our schools. HRO requires that we learn from crisis and we are certainly going to need to incorporate HRO principles in our learning systems and facilities. David has a good start on that, having created an ad-hoc HRO organization in the midst of a raging crisis. Hat’s off to him and his team!

I was fortunate to have the opportunity to teach a class of Healthcare graduate students about HRO. I'm excited to bring this to the podcast. To make it manageable I divided this 90 minute introductory class up into a 3 Part Series.This Episode is Part 3. It introduces some of the human-centric aspects of HRO and what is important in implementing HRO concepts.Part 1 Takes class through a bit of history about HRO, as this gives important context as to why it's important an what it's about. From there the class learns the definition of HRO and we break that down to focus on the various aspects of HRO.Part 2 I take the the class through the 5 Habits of HRO, define them and look at some practical aspects of them.

I was fortunate to have the opportunity to teach a class of Healthcare graduate students about HRO. I'm excited to bring this to the podcast. To make it manageable I divided this 90 minute introductory class up into a 3 Part Series.This Episode is Part 2. I take the the class through the 5 Habits of HRO, define them and look at some practical aspects of them.Part 1 Takes class through a bit of history about HRO, as this gives important context as to why it's important an what it's about. From there the class learns the definition of HRO and we break that down to focus on the various aspects of HRO.Part 3 introduces some of the human-centric aspects of HRO and what is important in implementing HRO concepts.

I was fortunate to have the opportunity to teach a class of Healthcare graduate students about HRO. I'm excited to bring this to the podcast. To make it manageable I divided this 90 minute introductory class up into a 3 Part Series.This Episode is Part 1. I take the class through a bit of history about HRO, as this gives important context as to why it's important an what it's about. From there the class learns the definition of HRO and we break that down to focus on the various aspects of HRO.Part 2 Takes the 5 Habits of HRO and defines them and looks at some practical aspects of them. Part 3 introduces some of the human-centric aspects of HRO and what is important in implementing HRO concepts.

Every year, Santa is called upon to deliver the goods. This gripping expose' gives insight into the behind the scenes at the North Pole. In a slight tongue-in-check episode, we offer a collection of different HRO changes to consider, using Santa and his workshop to get you thinking outside of the toy box.Practically speaking, HRO is hard. There is so much to consider and the challenge of knowing what effort makes the most sense first can seem as daunting as the mall the day before Christmas. Well, sit back, grab a hot cocoa and some cookies and listen to how Jolly Ole Santa Claus has built a High Reliability holiday juggernaut and give some thought to what to ask Santa for Christmas.This is the season finale for this year. Many of you might be looking at some form of High Reliability implementation in the New Year and like many leaders are having a hard time identifying what’s your next (or first) step. I hope you enjoy today's season finale and all of this years episodes. Thanks to all the listeners and followers for helping grow our podcast this year. Next year is already taking shape. Happy Holidays and Happy New Year!

Jeff Bezos may have coined the phrase "failure and innovation are inseparable twins", but Charlie d'Estries brings it full circle with his perspective that there is no difference between HRO and failure. In other words, Innovation and HRO both require failure.Charlie, scientist, businessman, entrepreneur and author, brings his renaissance perspective to HRO. He offers a fresh take on how failure makes people, and companies, better at managing risk.

Nurses touch so many lives. They are the very front line on healthcare. They are the point at which hospital operations, risk management, and care giving come together. Their actions can literally be life or death, and certainly they are highly committed to the job they do and the folks they take care of (namely you and me).This episode discusses the 5 principles of HRO in the daily setting of an oncology hospital. The conversation focuses on the daily operational efforts of nurses and concludes with an example of how HRO can be applied to a nurses daily responsibilities.Thanks to Jacque Henry for her time and awesome stories.

Recognize: Recognize your people. Recognition positively impacts engagement. And right now, more than ever, an engaged workforce is your greatest asset and your best defense during this crisis.In the frenzy and the disconnect between how we are used to working versus how we are working, leaders are not devoting enough time to consistently recognizing their people that pulled together to reinvent and sustain operations under tremendous duress.We aren't talking about a strategic approach to managing a transactional rewards program that spits out trinkets and gift cards. We are talking about the real deal; the human act of personally singing the praises and acknowledging the invaluable contributions of individuals and teams that made the impossible, possible. Let’s take a second to fundamentally make the hard-line connection between recognition and engagement through the lens of HRO. The down and dirty purpose of High Reliability Organizing is to avoid known and unknown catastrophic threats that could compromise operations and outcomes in complex, high stakes, fast-paced industries…healthcare, aerospace, and nuclear energy. Recognizing the power of engaged employees to protect the systems and processes that affect outcomes is at the heart of HRO. These are simple equations.Recognized employees are energized and engaged employees.Appreciative leaders are appreciated leaders. If you lead from your heart and your head through this crisis, you’ll emerge with an aligned and energized organization that is better prepared for whatever is coming next. It doesn’t get any simpler than that.The question is “What do you want more of?” An old friend used to say that “more is better” and when it comes to “improving the function of your organization”, you set the expectation and tone for what you will get more of…Do you want more innovation, recognize it.Do you want more expertise, acknowledge the power of it.Do want a culture of engagement and proactivity, highlight it every time you see it. Great leaders speak the language of more.If you want your working culture to adopt an aptitude for continuous improvement, you have to cultivate, recognize and reward it. Challenge the entire leadership team to recognize and elevate your people, privately and publicly, in real and meaningful ways.Use your positions to raise others up. In doing so, you’ll improve the function of your organization. So, what you and your leadership team need to do is start is to schedule time to pop in to see every team and department across the organization, across all shifts. Come in early, stay late over as long as it takes. And when you get through every team and department, do it again. The goal is to recognize the expert contributions that teams or departments made throughout the transition that sustained operations or protected outcomes. Be specific. Plan to spend 30 minutes with the group. Find out what they need to succeed. Listen to them, support them, and thank them. Go into the experience with the intention of making a meaningful connection with the contributors, despite it being a group pow-wow.Here’s the moral of the story…High reliability organization’s develop repeatable systems, formal and informal, that reinforce operational excellence. Developing a culture of support and gratitude for one another starts with you popping in consistently to thank people for hard work and credible expertise that you can count on.In closing…Pull your leadership team together. Let them know that you expect praise to be free flowing across every layer of the organization. Together commit to promoting a recognition-rich culture.

Manage PerformanceEven in crisis, especially in crisis, you have to manage performance if you want to maintain any continuity across your routine business operations. We are running lean and pulled in different directions, but:If outcomes matter, you have to manageIf talent matters, you have to manageIf quality, safety and delivery of service or product matter, you have to manage performance.If culture matters…Preoccupation with Failure: Recognizes that big threats usually start as small problems.There is nothing more important than aligning your employees, resources, and systems to meet the new reality.Employees are likely to be the single biggest determinant in how fast and how well an organization recovers from a crisis. How you manage performance, goals, expectations and talent during the crisis will have a direct impact on your ability to move forward.Putting people first now, protects the future.Reluctance to Oversimplify: Look to simply the solutions do not oversimplify the threat.Maintaining the normal functions feels normal. Which is a comfort for most people when everything is not normal.Uniting your employees around the common goal of doing their best to run “business as usual” is a relief to people during a crisis.Sensitivity to Operations: More can always be done to improve the function of an organization in real time.More can always be done to improve the function of an organization in real time if you know what needs to be done. Managing performance provides leaders with a certain sense of what needs to be done.Commitment to Resiliency: Organizations ability to adapt under stressful circumstances.The way that you work undoubtedly changed.It’s very likely that your traditional approach or understanding of performance management may need to be deconstructed and re-conceptualized. You just need an abbreviated approach to managing that focuses on setting new goals and new measures …with a heavy emphasis on coaching and feedback that moves people forward.People learn faster through feedback. Deference to Expertise: In high reliability organizing, every individual in any and every role should be trained and encouraged to see themselves as an expert in that particular operation.This is the time to encourage initiative and empower people at all levels of the organization.Experts are born during crisis.I’ll give you an example…You have teams and individual performers who are problem-solving their way out of challenges every day. You want to know who they are- you want to recognize their roles. Some of them will surprise you. You want to invest in those that are invaluable to the organization.Another way to cultivate expertise is to invest in expertise. If you have the resources and the capacity, you should be invested in developing talent at every layer right now. You can’t know who needs what unless you are managing performance.

We were forced to adapt to change that we weren’t ready for and didn’t want. And more change is coming, but we don’t know what it looks like or how it is going to affect us.All of which is exhausting.When the rate of change won’t change, we have to adjust our headspace… Otherwise …we’ll be reduced to reactive zombies.Your organization is full of people uncertain about the future. They might be showing up every day, working from home, or furloughed. Doesn’t matter. They might love you, hate you, trust you, distrust you…Doesn’t matter. What matters is that you dig deep and refocus the contributors on all that we do know: who we are, why do we matter, what are we doing and are we prepared for what’s coming next. In times of uncertainty, we listen for the confidant for direction. Remind everyone that despite all that you don’t know, somethings, the most important things are certain. Answer the questions that are going to carry you forward whether you have all the concrete answers or not.What questions?What do you do and what are we doing that actually matters?Why are we doing it?And what are we accomplishing?The answers to these simple questions are bigger than the daily grind, of absorbing stress and fighting off all the threats.Be vulnerable.There is a higher order purpose to your work. Define it, communicate it and reinvigorate everyone’s headspace while we are in this weird lull.

We have a lot working against us right now. Your 2, 3, 4 weeks into a radical transformation operations, complete re-organization of how and where. Your infrastructure's stable, but, completely consumed by disruptions.So for that reason, One thing, one seemingly small thing that exhausted leaders can do today is to focus on being clear and very definitively specific when communicating plans, expectations, and changes. Fatigue effects our performance especially our speech and listening capacity. It’s important to remind yourself that you are exhausted, remind yourself that you have to think differently about how you communicate right nowPreoccupation with Failure: Recognizes that big threats usually start as small problems. Big threats are consequence of not enough words, so use clear speech, don’t start rapid firing directives, slow down, take a breath, organize your thoughts. Speak in full sentences. Outline the steps. Give context. Define the measure or clarify the boundaries. Take the time to communicate precisely to the stressed and fatigued people around you. Look to simply the solutions do not oversimplify the threat. Right now, it’s a mistake to believe that anything is obvious! Consider it your role right now to communicate the obvious. Do not assume that everyone knows what you know. Remember, we all have our own mental contexts and life experiences that complicate our ability to understand each other in low stress states. Now in high stress states, we need to go to the next level when communicating. The only way to ensure that the meaning of your message is understood, is to clearly define the specifics. Organize information in simple steps and plain sentences. More can always be done to improve the function of an organization in real time. Consider, essential employees report exposure. But, what does expose mean? My definitions of exposure, not yours? Does exposure mean that you spent 15 or more minutes within a 6’ range of someone that is waiting for a test, has tested positive or is hospitalized? Use whatever definitions that you trust, but by defining the specifics you are accomplishing four goals: One: Minimizing a threat to your workforceTwo: Protect scarce resources Three: educating your working culture by offering one more clear safety standard for them to observe. Four: By defining the ask and tasks in detail, you are more likely to realize the outcomes you have defined. Now isn’t the time to be vague

One Small Thing - On the Same Page

You have team members that you are trying to keep employed while they juggle childcare or whose roles are so radically altered by working from home that they have capacity to own process review work. Utilize these human resources to organize and update the backbone of your operations. HRO TIP - Use Remote Work Staff to Improve/Write processesOne thing that every contributor can do while working remotely is review the processes and work instructions that define the tasks and the workflow within their department and across departments. If you have never developed processes or work instructions, now is the time to start. All any employee has to do to begin the process is document the steps that they take to achieve any particular outcomes. If you want your working culture to adopt an aptitude for continuous improvement, you have to cultivate it. Operational reforms are most effective and the least disruptive when they empower, recognize contributor’s expertise and make sense. Common pitfalls and obstacles companies put in front of their staff include:No role in creating the processes that define their work. You do not recognize your people as experts if you do not allow them a role and a voice in defining their work. If a process is being followed, but it isn’t working, I guarantee you that the team that runs that process knows why it isn’t producing the desired impact. Not every employee is qualified to review company policy, but every employee should have a critical role in reviewing and designing processes and work instructions that define their functions.Now is the time, seize the moment to attend to all of those big needs that never get the attention that they deserve. A simple set of bullet points will lay a solid foundation. Applying resources towards process reviews is an investment in achieving uncommon outcomes when everyone returns back to work. Keep the ask simple. Have the teams identify the processes that need updating. Pop the processes up on a collaborative site that allows multiple users to work together on shared documents in real time. Ask for very practical feedback:Is the process clunky or difficult to follow? Does the process produce the intended objective? Can they define the objective?Are employees using new technologies that the process doesn’t acknowledge? Has the department grown, adding new roles and functions that aren’t identified? And finally, once the review is finished, request that all comments, notes, and recommendations are submitted to one “owner” that will set a date somewhere down the line, when we aren’t combating a crisis, to organize process development pow-wow that gets the updates into practice.

Here are some tips to try if you are looking to bring HRO into your business.HRO TIP - Wash Your Rings, Watches, PhonesWashing your hands is a must. And yet there's more to be done... jewelry, watches, fitbits, rings need cleaning. Your phone and other surfaces are other recommendations for sterilizing to lower the potential for transmission.BackgroundLike millions of others around the world, we are being impacted by the Covid-19 Pandemic. If ever there was a time to be safety and quality conscious, it is right now. And although our team is not in a risk category, we're still following the rules and procedures that local and state government are providing. Despite many folks early dismissal of the novel corona virus, no one looks as though they are going to avoid disruption and impact to their lives, families and businesses.During this crisis, we’ll be providing tips and practices that you can use to rise the level of safety and quality in your organization during and after the crisis. Practically speaking (and what may appear to be contradictory) the best time to start to implement HRO is now, crisis or not because this situation will expose the gaps and missing processes in your system. Thanks for listening. Please practice your own version of HRO by following local government and medical leaders directives and programs, even if they don’t seem to affect you or you don’t think they apply. As in all HRO environments, working together reduces the impacts of errors and improves the potential for positive outcomes in a crisis. Wash your hands, avoid crowds and be mindful.... and safe.

Here are some tips to try if you are looking to bring HRO into your business.HRO TIP -Staff HotlineSet up a call in system to allow your temporary work from home staff to offer suggestions on improving processes, addressing safety and other challenges, and providing ideas and suggestions on how to better work in socially distancing situations.BackgroundLike millions of others around the world, we are being impacted by the Covid-19 Pandemic. If ever there was a time to be safety and quality conscious, it is right now. And although our team is not in a risk category, we're still following the rules and procedures that local and state government are providing. Despite many folks early dismissal of the novel corona virus, no one looks as though they are going to avoid disruption and impact to their lives, families and businesses.During this crisis, we’ll be providing tips and practices that you can use to rise the level of safety and quality in your organization during and after the crisis. Practically speaking (and what may appear to be contradictory) the best time to start to implement HRO is now, crisis or not because this situation will expose the gaps and missing processes in your system. Thanks for listening. Please practice your own version of HRO by following local government and medical leaders directives and programs, even if they don’t seem to affect you or you don’t think they apply. As in all HRO environments, working together reduces the impacts of errors and improves the potential for positive outcomes in a crisis. Wash your hands, avoid crowds and be mindful.... and safe.

In our last major episode we interviewed Joe Bell Executive Director of the Niagara Aerospace Museum and retired aerospace industry executive. We covered a wide range of topics in our interview. We couldn’t share all of the stories and lessons in one podcast, so we’ve created a few standalone podcasts to share more of Joe’s stories.In this mini episode, Joe shares a couple of stories from the front lines of reliability, quality and HRO. High Reliability can start long before the product is designed. By understanding how a product is used, what the users face, the environment its used in product designers and reliability engineers can not only make sure a product solves the problem its intended to deal with, but can ensure that it doesn’t create another potential crisis or failure point. Practically speaking “Unless you go out and live it, you can’t see it”.

Season 2 Episode 001This High Reliability podcast is an interview with Mr. Joe Bell, Executive Director of the Niagara Aerospace Museum and retired Aerospace Executive. Joe has more than 4 decades of experience in quality, reliability, and culture in the Aerospace Industry. In this episode Joe offers practical insights into the 5 HRO habits, how to help teams use these habits and provides some intriguing stories from an industry insider. Links:Niagara Aerospace Museum: https://niagaraaerospacemuseum.org/TReC Coworking Space: https://trecbyngti.com/

This is the season finale for this year. Many of you might be looking at some form of High Reliability implementation in the New Year and like many leaders are having a hard time identifying what’s your next (or first) step. In a slight tongue-in-check episode, we offer a collection of different HRO changes to consider, using Santa and his workshop to get you thinking outside of the toy box.Practically speaking, HRO is hard. There is so much to consider and the challenge of knowing what effort makes the most sense first can seem as daunting as the mall the day before Christmas. Well, sit back, grab a hot cocoa and some cookies and listen to how Jolly Ole Santa Claus has built a High Reliability holiday juggernaut and give some thought to what to ask Santa for Christmas.I hope you enjoy today's season finale and all of this years episodes. Thanks to all the listeners and followers for helping grow our podcast this year. Next year is already taking shape. We’ll be adding interviews on a routine basis. We’ll be talking with practitioners and business leaders who practice High Reliability Organizing and we’ll be continuing our focus on implementation by interviewing folks who operate in HRO industries.HRO is a game changing differentiator for all types of businesses, but it is a challenge. Putting HRO into practice is a deeper effort than simply bringing third party training on board and then leaving the team to dig in. It takes investment, commitment and experience. If your wish list for next year includes HRO in some fashion, let’s connect. My expertise runs the gamut… I can help you chart a course forward, collaborate with the implementation team, mentor the leadership team, embed myself in an project to work side by side or I can come on board full time to lead an extensive program.

We often talk about business in the abstract, philosophies, strategies, what ifs. This episode looks at an ongoing crisis, with direct and fatal consequences for those involved. Rather than debate the technical and operational aspects, this podcast aims to draw attention to the underlying and pervasive role that culture plays in companies. If all we focus on are the processes and procedures, and ignore the business decisions regarding people and culture, we have missed a critical opportunity to help change the way businesses operate.There have been volumes already written about these accidents, and volumes more will be. Much has been written about the design, technical, training, service, business, and regulatory aspects and decisions at the core of these accidents. So what was it that really changed, what is no longer done, or believed, or understood? What changes brought on the collision of deregulation and Wall Street? Was there something that fundamentally makes the difference when collectively considering the long-term implications of deregulation, Wall Street, and all the other aspects? I believe there is. It is High Reliability Organizing.

This episode looks at the first step necessary to implement HRO in your organization – leadership buy-in. While the implementation, execution and benefits of HRO are unique to every business, there are some practical steps that every organization has to take, the first of which is buy-in by the folks running the organization. Without the commitment, in time, talent and treasure, this effort will stall. It happens far more often than not, despite it being one of the best means of differentiation in the market.There is an outline of Step 1 on my blog at PracticalHRO.com. Practically speaking, you’ve got to get buy-in before you can move forward.

This episode looks at a critical aspect of implementing High Reliability Organizing – specifically where in the organization does it belong? Who should lead HRO efforts? Where do HRO processes, issues and, ultimately, decisions come from? What happens when HRO conflicts with another primary business objective?Using org structure to support and match the HRO framework addresses this so it should be strategically thought through. In general, the argument I put forward is that it should emanate from close to the top of the organization, but likely not the tippity top.

Our case study is set at a medium size regional hospital, working to develop strong credentials from a variety of agencies like Agency for Healthcare Research and Quality (AHRQ). Over time hospital leadership had sought to improve patient experience scores and had tried a number of efforts, typically in specific, siloed operational departments. Few of these efforts brought significant improvement, which, over time, was becoming a challenge for the organization. 0:42 Today’s Episode1:20 Definition: HRO 2:25 Case Study Intro2:48 Part I: Accepting a Simple Cause4:08 Part II: The Review8:17 Part III: Weak Signals11:07 Part IV: Lessons Learned

This is our third podcast in a series focusing on high reliability organizing. Our first podcast took on the basic definition. This and the previous podcast look at the 5 principles of mindful organizing. Episode 3 specifically looks at the last two principles that collectively form the containment portion of HRO. Following that is our section on topical information such as news or book reviews. Episode 3 reviews a recent article by the medical director and patient safety officer for the Division of Healthcare Improvement at The Joint Commission. As usual, the episode ends with a discussion on some aspect of implementing HRO. Episode 3 specifically looks at H. R. O. with an quick Health Care case study that demonstrates that root cause is very often not what you think it will be, which can get in the way of the organization addressing the issue. 0:57 Today's Episode2:35 HRO Framework Review3:50 The Containment Habits4:55 Failures, Mistakes and Accidents, Oh My14:45 Expertise Does Not Always Live Where You Think It Does25:35 HRO in the News: Dr. Ed Pollack, Joint Commission 30:15 HRO Implementation – The Case of the Missing Valet

In its most basic form Risk Management recognizes one basic truth… mistakes happen. In response to this, organizations should prepare two complimentary collections of actions (1) – establish methods to anticipate risks to prevent them and (2) – when prevention fails, establish methods to contain the results. In addition to preventing mistakes and then limiting the impact, these two collections of actions form a feedback loop that improves the risk management outcomes over time.This episode explores the Anticipation Habits. In the "HRO In The News" section we look at HRO and the Veterans Hospital Administration. The closing section investigates the implementation of a Just Culture over the typical culture of blame.

This is the first podcast in a series focusing on high reliability organizing so it's an introduction to the concept. Our first segment opens up with a definition of HRO in the 5 habits that make up the framework of higher reliability organizing Following that will have a section on topical information such as is our own and news or book review and in this podcast we look at this year's Malcolm Baldrige award winners The podcast will end with a discussion on some aspect of implementing HRO in today specifically we look at H. R. O. in a section called HRO is not the program of the month.