The Joint Commission Center for Transforming Healthcare’s Oro 2.0 High Reliability Organizational Assessment application is designed to help guide health care organizations on their journey to more predictable and better outcomes. Specifically, the tool is designed to help organizations assess their current level of maturity in 14 areas of performance in the domains of leadership commitment, safety culture, and performance improvement.
The Henry Ford Health System (HFHS), located in Detroit, MI, was one of the first systems to pilot test the tool. Michelle Schreiber, MD, senior vice-president and chief quality officer at HFHS, recently described the organization’s experience using Oro 2.0 in The Joint Commission’s Physician Leader Monthly.*
HFHS’ first steps toward high reliability
The Web-based Oro 2.0 is free to hospital and critical access hospital accredited health care organizations. The first step for organizations is a self-administered, anonymous questionnaire that the senior leaders of the organization complete individually. The next step involves a facilitated discussion that brings together the key leaders of the organization to reach consensus on the best answer to each question. The application then assigns a level of maturity for each of the 14 areas of performance based on the answers to the questions.
Dr. Schreiber said that HFHS used the tool to identify the organization’s readiness for the high reliability journey. Leaders in the health system thought it would take the organization to the next level after receiving the 2011 Malcolm Baldrige National Quality Award—the nation’s highest presidential honor for performance excellence through innovation, improvement, and visionary leadership.
HFHS used Oro 2.0 to survey the leadership, including the board of trustees, at the organization’s four acute care hospitals. “Our answers were a pretty broad mix. Many of the questions had a broad range of individual responses, and at the facilitated discussions, there was significant discussion to arrive at a consensus,” Dr. Schreiber said.
“I think this conversation was very important—both in seeing how individuals had answered (using the grouped, anonymous responses) and to discuss openly some of the issues and challenges.”
Dr. Schreiber said the answers and scores, ranging from “advancing” in some areas to “beginning” in others, weren’t all that surprising, as she was anticipating a broad assortment of responses.
Starting a conversation
“The most valuable part of the assessment was the conversation itself,” she said. “It is not often that most leadership groups take the opportunity to step back and assess culture as it relates to quality and high reliability, and this was a wonderful chance to have a facilitated conversation with real-time answers to important questions and come to a consensus.”
Dr. Schreiber also said that she wondered how the frontline staff would have answered the questions in the survey.
“Oro 2.0 is designed for leadership, but I think posing the same or similar questions to frontline staff would provide another level of valuable insight,” she said.
Surgeons see firsthand the results of preventable harm caused to patients; as such, they are a group that can help champion the high reliability cause at their organizations by encouraging leadership to use Oro 2.0.
Dr. Schreiber said she would recommend Oro 2.0 to other organizations. “This was a great opportunity to safely assess the culture of the organization as it pertains to quality and high reliability, including the key components of improving our performance and our value to the customer, our patients,” she said. “I suspect most organizations will find they are at mixed levels of readiness—from ‘beginning’ to ‘advancing’—and no organization in health care has likely achieved full high reliability. So, there are opportunities for all to learn.”
For more information about Oro 2.0, visit the Center for Transforming Healthcare’s website.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
*The Joint Commission. Special focus on Oro 2.0. Physician Leader Monthly. June 17, 2016. Available at: image.jointcommission-email.org/lib/fe9515707360037c72/m/3/ORO+and+HFHS+Schreiber+FINAL.pdf. Accessed July 27, 2016.