Presentation
Operational Health Briefings: Getting Safety a Seat at the Big Table, and Keeping It
DescriptionPatient safety, and safety management more generally, is typically spoken of as a deeply held value, but often has limited influence in shaping operational decisions. The same often holds true for human factors and ergonomics (HFE). Although that influence can rise under certain conditions, including during the tenure of a particularly effective safety leader or after a safety-related crisis, it can just as easily fall. Financial and other considerations dominate boardroom deliberations. This can be seen in how non-safety considerations shape future budgets, influence the prioritization of future initiatives, and even in the time allotted to them in the agenda in recurring executive meetings.
In our presentation, we will describe the Operational Health Briefing (OHB), which is a synthesis of a number of different operations-related disciplines, including patient safety, occupational safety, process improvement, quality management, and HFE. It draws from concepts and methods from each of these disciplines as well as from cognitive systems engineering (CSE), resilience engineering (RE), and high reliability organizing (HRO). By integrating the outputs of these different but complementary disciplines, the OHB is designed to provide decision-making information as a counterbalance for solely financial decisions at various levels of the organization. The OHB has been developed to accomplish the following four overarching objectives:
Provide a balanced and contextual assessment of the health of operations, which includes the frequency and severity of issues, the state of current capabilities, and the organizations’ responses (strains) to the challenges (stresses) that it has encountered.
Provide periodic snapshots of operational health (i.e., incident-, competency-, and adaptation-based assessments) so that they can be readily compared with previous snapshots to facilitate comparison and identification of trends.
Streamline OHB production processes so that it can be generated and delivered at a cadence that ensures that it is current and consistently provides valuable insights and recommendations.
Align the OHB’s insights and recommendations with non-operational goals, such as financial considerations and goals, in order to create a lingua franca across seemingly incomparable requests and suggestions across the various organizational departments.
The OHB creates a balance between incidents, capabilities, and adaptations by integrating methods and analytical streams focused on each of those three crucial perspectives. Top-level results from standard incident-reporting mechanisms are included in the OHB, but are set in context of both historical data and the insights of the other two perspectives. Capabilities analyses are integrated from the current process improvement, operational excellence, HFE, HRO and RE initiatives. These are designed to show the relative performance level of critical operations functions over the OHB’s time window, with the ability to compare current performance with previous time periods’ performance. Adaptations analyses include new views of critical operations functions’ performance designed to show how performance changes relative to a number of different challenges and the magnitude of those challenges. This is augmented by the results of dynamically directed interviews and self-reports from a variety of frontline practitioners, allowing the OHB to not only report on what is happening, but also why it is happening.
The OHB combines a series of written accounts and recommendations with multiple visual analytics techniques designed to complement the briefing and allow decision-makers to see a large amount of information at once, organized in a way that allows insights to emerge. Inputs to the OHB include structured data coming from the organization’s data repositories, manual analysis of currently running projects, and the results of any recently completed projects. These allow decision-makers to see current performance in the context of historical performance. Inputs to the OHB also include the results of computational models and the adaptation-based analyses. These allow decision-makers to anticipate future performance trajectories based on predicted internal and external factors and the likely effects of proposed interventions.
We will share the results of our current OHB pilots at five Sterile Processing Departments (SPD) across two US tertiary-care teaching medical centers. These OHB pilots use a combination of Systemic Contributors and Adaptation Diagramming (SCAD) interviews, Systems Engineering Initiative for Patient Safety (SEIPS) tools, visual analytics displays of a number of performance measures, a computational model of surgical tray processing effectiveness and throughput, and abstraction networks to generate the various components of the OHB. They contain a mixture of automatically-generated as well as manually-generated content. Our discussion will include:
Insights on the most effective timing, audience considerations, and the most valuable components that make up the OHB.
Trade-offs between including aspects of the OHB that are more familiar to the various audience groups and introducing new displays and aspects that are more experimental and potentially foreign to these audiences.
The ability for the OHB to introduce new concepts and the utility of new operations-based practices (including new safety practices) that are otherwise foreign to the OHB’s audiences.
What surprised us as we have worked through these pilots.
Our presentation will include examples of OHB’s that were presented to the two pilot institutions as well as decision makers’ reactions to individual portions. It will also include what portions of the OHB are more mature, which have successfully become pragmatic enough to present reliably at the desired cadence, and where we are still working to improve. We will also share the open questions that we still have.
The objective of our presentation is to share our insights on how to implement a well-rounded safety program that is explicitly integrated with other forms of systems engineering, with the option to have an integrated output that is explicitly crafted to eliminate the gap between systems engineering insights and business decisions that result in actionable plans. We believe that programs like the OHB will position safety management and HFE differently within the organization, giving them a long-desired seat at the table and, not coincidentally, arming them with much more compelling insights to share!
In our presentation, we will describe the Operational Health Briefing (OHB), which is a synthesis of a number of different operations-related disciplines, including patient safety, occupational safety, process improvement, quality management, and HFE. It draws from concepts and methods from each of these disciplines as well as from cognitive systems engineering (CSE), resilience engineering (RE), and high reliability organizing (HRO). By integrating the outputs of these different but complementary disciplines, the OHB is designed to provide decision-making information as a counterbalance for solely financial decisions at various levels of the organization. The OHB has been developed to accomplish the following four overarching objectives:
Provide a balanced and contextual assessment of the health of operations, which includes the frequency and severity of issues, the state of current capabilities, and the organizations’ responses (strains) to the challenges (stresses) that it has encountered.
Provide periodic snapshots of operational health (i.e., incident-, competency-, and adaptation-based assessments) so that they can be readily compared with previous snapshots to facilitate comparison and identification of trends.
Streamline OHB production processes so that it can be generated and delivered at a cadence that ensures that it is current and consistently provides valuable insights and recommendations.
Align the OHB’s insights and recommendations with non-operational goals, such as financial considerations and goals, in order to create a lingua franca across seemingly incomparable requests and suggestions across the various organizational departments.
The OHB creates a balance between incidents, capabilities, and adaptations by integrating methods and analytical streams focused on each of those three crucial perspectives. Top-level results from standard incident-reporting mechanisms are included in the OHB, but are set in context of both historical data and the insights of the other two perspectives. Capabilities analyses are integrated from the current process improvement, operational excellence, HFE, HRO and RE initiatives. These are designed to show the relative performance level of critical operations functions over the OHB’s time window, with the ability to compare current performance with previous time periods’ performance. Adaptations analyses include new views of critical operations functions’ performance designed to show how performance changes relative to a number of different challenges and the magnitude of those challenges. This is augmented by the results of dynamically directed interviews and self-reports from a variety of frontline practitioners, allowing the OHB to not only report on what is happening, but also why it is happening.
The OHB combines a series of written accounts and recommendations with multiple visual analytics techniques designed to complement the briefing and allow decision-makers to see a large amount of information at once, organized in a way that allows insights to emerge. Inputs to the OHB include structured data coming from the organization’s data repositories, manual analysis of currently running projects, and the results of any recently completed projects. These allow decision-makers to see current performance in the context of historical performance. Inputs to the OHB also include the results of computational models and the adaptation-based analyses. These allow decision-makers to anticipate future performance trajectories based on predicted internal and external factors and the likely effects of proposed interventions.
We will share the results of our current OHB pilots at five Sterile Processing Departments (SPD) across two US tertiary-care teaching medical centers. These OHB pilots use a combination of Systemic Contributors and Adaptation Diagramming (SCAD) interviews, Systems Engineering Initiative for Patient Safety (SEIPS) tools, visual analytics displays of a number of performance measures, a computational model of surgical tray processing effectiveness and throughput, and abstraction networks to generate the various components of the OHB. They contain a mixture of automatically-generated as well as manually-generated content. Our discussion will include:
Insights on the most effective timing, audience considerations, and the most valuable components that make up the OHB.
Trade-offs between including aspects of the OHB that are more familiar to the various audience groups and introducing new displays and aspects that are more experimental and potentially foreign to these audiences.
The ability for the OHB to introduce new concepts and the utility of new operations-based practices (including new safety practices) that are otherwise foreign to the OHB’s audiences.
What surprised us as we have worked through these pilots.
Our presentation will include examples of OHB’s that were presented to the two pilot institutions as well as decision makers’ reactions to individual portions. It will also include what portions of the OHB are more mature, which have successfully become pragmatic enough to present reliably at the desired cadence, and where we are still working to improve. We will also share the open questions that we still have.
The objective of our presentation is to share our insights on how to implement a well-rounded safety program that is explicitly integrated with other forms of systems engineering, with the option to have an integrated output that is explicitly crafted to eliminate the gap between systems engineering insights and business decisions that result in actionable plans. We believe that programs like the OHB will position safety management and HFE differently within the organization, giving them a long-desired seat at the table and, not coincidentally, arming them with much more compelling insights to share!
Authors
Event Type
Oral Presentations
TimeWednesday, March 258:30am - 8:52am EDT
LocationMurray Hill East
Patient Safety Research and Initiatives