What Leaders Are Saying About the HRO Journey and Transparency

Cincinnati Children’s Hospital has been on their high reliability journey for a number of years. As such, they have embraced transparency as one of their five defining characteristics along with: 1) Leadership 2) Institutional infrastructure, organizational alignment, and resource investment 3) Rigorous measurement and 4) Accountability.

Here’s what they had to say about transparency in the AHRQ report I shared in yesterday’s post.

In a culture that stresses continuous improvement, easy and open access to information is essential. Like other organizations that have embraced high reliability organizing, Cincinnati Children’s embraces the belief that open communication is necessary for its transformation to succeed. The following are key aspects of transparency:

  • Transparency must span all levels of the organization. Holding information about organizational successes and failures at the leadership level often can be counterproductive. If you don’t make information available to all staff, they cannot fully participate in rapid-cycle improvement. Moreover, in order to motivate staff to change behaviors and give them freedom to think creatively about potential improvements, they need full access to information about what is working well and what could be working better. Once information is shared, the opportunity exists to actually address the underlying cause.
  • Transparency must include recognition of successes as well as failures. Improvement can only occur if failures are identified and addressed, but building a culture of trust that encourages staff to report failures is difficult. Cincinnati Children’s has worked with one unit in particular to increase reliability and celebrate successes. When a near-miss event takes place and a staff member accurately records the event, that staff member is acknowledged for reporting the event. Because continuous improvement efforts will entail both successes and failures, communicating about both is essential for transformation to occur.
  • Transparency should include patients and families. Sharing information with patients and families can actually alleviate questions and concerns that may arise during the course of care. The key is to ensure that any information shared is presented in a way that is meaningful to the families and is easily understood. Involving families in organization wide advisory councils and unit-based improvement teams is an effective way of sharing information and soliciting feedback on opportunities for improvement. In some units of systems in the HRO Learning Network, information about unit performance is posted in public locations where it can be seen by patients and their families.
  • Transparency should occur through multiple media. Reporting information in multiple locations and through multiple media increases the odds that the information will be seen by a larger audience. Cincinnati Children’s takes advantage of bulletin boards, computer screen savers, its intranet, and the Internet to share information with staff, patients, and families. Although it is a challenge, the organization has made a commitment to posting information in ways that patients and their families will be able to understand and use.

Excellent insights on the power of transparency in leading change towards clinical care excellence. Great things usually happen when people are transparent about their outcomes and can learn from the data. Transparency is also about having open and honest conversations between caregiver and patients…even at the most difficult of times. We have always believed transparency starts with the first conversation between patient and caregiver. From informed consent (or preferably shared decision-making) to end-of-life discussions, understanding a patient’s preferences, values, needs and goals helps set the stage for truly transparent and un-biased conversations that produce meaningful decisions. More on transparency as it relates to open and honest communication in informed consent to follow.

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