By Dean Skillicorn
In this column, I will write about high reliability operations/organizations (HRO) which is the new buzz in quality management in health care and other industries. Balanced around safety, HRO is the concept that above all other aspects of operations, safety comes first. In health care that means patient safety comes first above all else. Our operations are built around patient safety. It has been that way for many years, with The Joint Commission’s focus on safety through the environment of care.
So, why all the hoopla? HRO is about driving safety through every operational phase in your organization. It is about having the best safety outcomes. It is about a mindset, in my opinion, where “good” is never good enough. You have to be great! It’s about doing the right thing. It’s about high quality and not accepting average. It is not acceptive of the old phrase, “Good enough for government, good enough for me.” It’s about not looking the other way. It’s about standing up, taking responsibility and being held accountable.
Why is this important in medical imaging service? Simple. Safety is a huge priority at any time. Most importantly though is safety and quality during the installation of medical imaging equipment or any clinical equipment systems. It is paramount. Managing installation projects can be difficult. Project managers, construction vendors, OEM staff, HTM, IT and end users are all working to ensure that a project is finished “on time.” Yet, what about safety and quality? How many times have we been involved in projects where we get to the phase of turning it over to the OEM for their installation only to find things didn’t go as planned? We have weekly calls. We track progress. Yet, things still go awry. Why? In my experience, it’s because in these projects we fail to implement a simple procedure we are all familiar with from surgery procedures. It’s called a “timeout.” We fail to simply take a breath, hold for a minute and examine all phases of the project and if they were completed to the OEM’s specifications. All while we hold the construction crew and OEM accountable for performance.
The challenge is the OEM itself. It places the responsibility of complying with the “specifications” on the facility and the construction crew, yet desire not participate in validation of the construction and installation of floor plates, Unistrut, rails, etc. The OEM will say it’s the construction crew’s responsibility to meet its standards. I say hogwash. It’s the team’s responsibility and the OEM is part of that team. Try managing the trifecta of two to three vendors all on the same project for an installation. It can be a recipe for disaster if you don’t hold construction crews and OEMs accountable. High reliability in installations is a must! Look the other way and disaster will loom in the future. Safety will be compromised … and this will all happen on your shift.
Don’t look the other way, don’t deflect, don’t allow the “it’s only a small issue” excuse or accept poor to mediocre work. Your patients’ safety depends on you standing up, taking ownership and making certain all phases are acceptable to the vendor to be able to move forward. That means the vendor is involved in that review.
It’s holding the construction crew and sub-contractors accountable for their work. No mediocrity is allowed. There can be no short cuts to save cost or time. If the project time frame needs amending, do it. The pressure to complete on time is real. That pressure can cause contractors nightmares. Those nightmares can create opportunities to take short cuts, use substandard materials or perform inadequate work. How do you avoid these pitfalls? “Timeouts.” They may create a slowdown, yet if you don’t slow down, mistakes will happen that can cause further issues after installation is complete – issues that compromise operations and, more importantly, patient safety.
The fix? Timeouts and schedule plans that allow flexibility. Also, it requires courage. Courage to stand up, demand high quality and reliability. Make performance accountable. Remember … good is never good enough. You want high reliability, practice it, mean it, embrace it!
– Dean Skillicorn, CBET, is currently the manager for medical imaging services, IHT-HTM at St. Luke’s Health System in Boise, Idaho. He is a 36-year veteran of HTM with 28 years in management.
