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Topic Title: High Reliability
Topic Summary: High reliability in healthcare
Created On: 04/16/2018 09:29 AM
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04/22/2018 10:59 PM
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schhk8
jim schuette



We are working to be a High Reliability Healthcare organization and have been on this journey for several years. The organization has had many successes, but it has taken a lot of hard work and effort from many team members.
After performing a literature search, I found there is a lot of conceptual information on High Reliability in healthcare, but the tactical tools and implementation strategies of High Reliability have not been described.
The Joint Commission has developed RPI for use in house and on selected disease states. Institute for Healthcare Improvement has published various "levels of reliability" to guide organizations. However, I have found there is a lack of any "how to" information or guidance on this topic.
I have been investigating how to implement High Reliability and wondered if anyone had any thoughts or information on how to integrate Lean / TPS methodologies with the concepts of High Reliability? Could this be a better pathway to moving closer to High Reliability in Healthcare?
Thanks in advance.
06/08/2018 08:19 AM
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bmackeyvt
Brian Mackey



Every Lean Organization is highly reliable; however, not every highly reliable organization is Lean.

Some basic Lean tenets that translate well to healthcare that can aid a high reliability journey are: visual management boards, standard work (especially around escalation and care pathway compliance), safety huddles, stop-the-line processes, etc.
07/02/2018 01:48 PM
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tgormley358
Tom Gormley



There's a lot of overlap as you say between Lean and High Rel, but I don't think one can say confidently that every "Lean Org" is highly reliable. I guess it would depend on a clear definition of "Lean Org". I suppose if the definition is an org that has applied Lean deeply and consistently to safety and quality, across all processes and value streams, then that could work. But the most lean healthcare organizations, even after years of amazing improvement and culture change, are probably still not as reliable as organizations in highly reliable industries like air travel.
07/09/2018 09:57 PM
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schhk8
jim schuette



I totally agree a lean organization is not necessarily a highly reliable organization. High reliability is a different mindset than Lean.
My thoughts were that by using the TPS culture and management thoughts along with certain tools, we could provide a framework of how to improve the reliability of the hospital. Without the social-technical aspects of TPS driving the improvement, the tools of lean can only go so far. The TPS principles as described by Liker line up nicely with the 5 principles of Weick and Sutcliffe providing the tools that can move an organization to increasing levels of reliability.
07/09/2018 09:57 PM
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Mystique1221
Cassandra Brandl-Johnson



In my opinion, if you want your healthcare system to be high reliability and would like to implement Lean methodologies, you'll have to learn what your outcomes to what High Reliability means in your system and how your system should be recognized as High Reliability; then use Lean methodologies to reach those marks.
07/16/2018 09:47 PM
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43656
Adam Bowden



Lean is about waste removal and will hit a "glass ceiling" on reliability.

To get reliability you need Six Sigma as this focus is data and variation reduction i.e reliability.

Happy to discuss.
07/16/2018 09:47 PM
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TammieJ
Tammie Jones



For me, High Reliability describes an ideal end state that organizations attempt to achieve. Lean thinking is a methodology that can embed the principles in an organization and allow that organization to achieve high reliability. Lean is not only a way of thinking, but a way of behaving, leading, and allowing for improvement to occur. That means leaders provide resources, remove obstacles, and establish priorities.
07/25/2018 10:48 PM
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leanblog
Mark Graban



Adam - You "need" Six Sigma? Or "could use" Six Sigma?

Toyota doesn't use formal Six Sigma in their plants. Aren't they a "high reliability organization?"
07/31/2018 07:23 AM
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Robert_Simonis
Robert Simonis



Toyota does not use Six Sigma as a program or approach, but most of the TPS tools are designed to reduce variation, and the tools of Six Sigma are widely used. Standard Work, Kanban, 5S, etc, are methods to standardize. Standardization is the opposite of variation. Use of Design of Experiments is common in Toyota, as is Reliability Engineering. The biggest difference between a Lean approach and a Six Sigma approach is who does it: Six Sigma focuses on specialists (belts) to conduct studies and improvements as projects, and Lean focuses on having everyone involved and improving every day. The lean tools create stability, repeatability, and reproducability to about the 4 or 4.5 sigma level, so I only need the specialized statistical analysis for the very hardiest of problems. I use six sigma for about the sixth sigma of problems - about 3 or 4 in a million.
12/19/2018 03:19 PM
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355541
Stephannie Baker



Oh, I did not know this. Thank for sharing. This is such a new topic. I had no idea but seeing this question made me google the terms. I am really thankful that I found this forum
01/02/2019 11:09 AM
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355541
Stephannie Baker



Originally posted by: 355541

Oh, I did not know this. Thank for sharing. This is such a new topic. I had no idea but seeing this question made me google the terms. I am really thankful that I found this forum


I tried reading a lot about this topic and I found really interesting posts to help me out. I think it's really nice of you to be discussing this and helping out the community
01/08/2019 12:26 PM
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174263
Charles Toyne



This is correct, I also ue the real detail six sigma tools for the most complex projects, and for 99% of the time the basic problem solving tool will suffice, I undertake (to use my own terminology) a lot of "JUST DO IT" projects as its quicker, simpler, more cost effective, and more importantly team members don't get bogged down it trying to understand what we are trying to do.
01/08/2019 12:26 PM
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174263
Charles Toyne



This is correct, and I also only use the full range of six sigma tools on the most detailed and complex problems, choosing to use what I call the "Just do it" approach for 99% of problems, this is quicker simpler, less costly, and the team don't have to worry about using some of the complex 6 Sigma tools correctly.

Its exactly the same as selecting the correct tool from your toolbox to get the desired result.
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