Opinion | Resiliency Starts With High-Reliability Healthcare Systems

Organizations and broader society often emphasize individual resilience in the workplace. We saw this on display among healthcare workforces throughout the COVID-19 pandemic, as individuals on the front lines were celebrated for their resilience. While their hard work deserved every bit of the recognition it received, it contributed to professional burnout. Last year, leaders from the Centers for Medicare & Medicaid Services and the CDC identified an urgent need for resilient healthcare systems and emphasized how companies can devote attention to resilience as an organization rather than focusing solely on individual resilience, albeit equally important.

According to the American Medical Association, organizational resilience is the flexibility to pivot as new and unexpected challenges arise, and to absorb unexpected shocks that cannot be avoided even with proper planning. When leaders establish effective structures, protocols, and behaviors to achieve overall organizational resilience and close the gap for when crisis occurs, they create high-reliability organizations (HROs). However, this is no easy task and requires continual effort and attention to maintain.

Researchers within my organization performed an analysis of which practices are being used in healthcare and hospital systems so we could better understand what organizations have done — or could do — to be resilient and optimize the energy of their staff. From this we found that, in order to achieve organizational resilience, organizations must first recognize that they have a finite amount of energy, similarly to individuals. When a short-term crisis evolves, the energy and resources expended typically increase as we tap into energy reserves. Over time, as the crisis severity subsides, the expended energy becomes moderate.

During a prolonged crisis such as the COVID-19 pandemic, healthcare professionals had to expend high levels of energy, while the energy they had in reserve was slowly depleted — this is similar to what happened worldwide in hospital and healthcare systems. Routine quality and safety measures (such as infection prevention and readmission prevention) were certainly a priority pre-pandemic, but we now know they need even more focus and attention. Because of this, many organizations struggled to optimize their response to ensure the continuation of routine measures while also adequately responding to new challenges posed by the COVID crisis. This may have contributed to a decline of patient safety and quality care in some health systems.

Some organizations adopted reliability and resiliency practices prior to the pandemic, and so the increase in energy expended during the crisis was less severe. Within such organizations, safety was a fundamental cultural underpinning, daily management system practices such as system-wide tiered daily readiness huddles were routine practice, and universal error prevention behaviors were in place. This can foster an increase in safety culture and workforce engagement.

Organizations that have prioritized and remained committed to zero harm can manage crises more efficiently and effectively because their leaders and teams have intentionally prepared for unforeseen circumstances. They have shaped processes and exhibited behaviors in the early stages of operation that offset the severity of the crisis. Leaders must integrate these behaviors into their organizations from the top down so that these expectations reach all levels.

So, what type of preparation and practices might an HRO undertake?

A focused daily leadership check-in about safety events and risks that may have occurred in the past 24 hours can serve as a powerful tool for HROs. Leaders work with their teams to structurally examine issues that arose in the last 24 hours, follow up on previously identified issues, and communicate which changes are necessary to execute. This process ensures less energy needs to be expended to establish a team communication process in the middle of the crisis.

When HRO leadership structures and expectations are shared among all team members — from leaders to managers to staff — safety as a core value becomes a habit and hallmark of the organization. Preventing — or bouncing back from — failure becomes less extreme since resilient practices are integrated into the whole system.

What we’ve found in analyzing workforce engagement across health systems and hospitals nationwide is that when leaders are committed to organizational resilience that bolsters individual resilience, they’re able to better manage their resources and ensure that safety remains the core value. By implementing leadership structures that emphasize problem identification, problem-solving, and behavioral expectations, organizations can maintain successful operations and keep individuals engaged both during routine operations and in times of crisis.

Tejal Gandhi, MD, MPH, is chief safety and transformation officer at Press Ganey, the industry’s largest database of patient, caregiver, and physician feedback.