The high reliability journey: A look in the mirror with Oro 2.0

In the last two issues of the Bulletin, I have highlighted the Joint Commission’s Robust Process Improvement (RPI) methodology and how the RPI toolkit can be of benefit to surgeons and health care institutions. This last column in this particular series focuses on a new resource: Oro 2.0.

Self-examination for improved reliability

Created by the Joint Commission Center for Transforming Healthcare, Oro 2.0 is a Web-based application that is available to accredited health care institutions at no additional fee. The mission of the center is to help transform health care into a high-reliability industry where every patient receives excellent care, every time. Oro 2.0 is designed to help institutions on their journey to high reliability. It includes an assessment for hospital senior leaders and a resource library for all physicians and staff who work at the organization.

The assessment helps health care leaders plot where their institution is on their path to high reliability. It is meant to provoke an honest, in-depth conversation among senior leaders and create alignment. Senior leaders take the assessment individually and then come together as a group to take the assessment again, with the goal of reaching a consensus on their institutions’ strengths and weaknesses. Institutions that pilot tested the assessment indicate that the discussion is extremely valuable, as it allows the senior leadership team to align around the various aspects of high reliability—what they mean to their organization and where they need to focus their efforts.

The ability of Oro 2.0 to provide a snapshot of where an organization is on its journey across multiple components is one of the program’s key features, and it is critical to determining next steps. The Oro 2.0 assessment results can be used as leading indicators. Oro 2.0 can tell organizations where they have opportunities to grow and where they are high performers among the 14 different areas included in the assessment, which are as follows:


  • Board
  • Chief Executive Officer/senior management
  • Physicians
  • Quality strategy
  • Quality measures
  • Information technology

Safety culture

  • Trust
  • Accountability
  • Identifying unsafe conditions
  • Strengthening systems
  • Assessment

Performance improvement

  • Methods
  • Training
  • Spread

The assessment typically takes about two hours for the group to complete and to achieve consensus. It is recommended that a trained facilitator administer the assessment so that the senior team can focus on the discussion. The assessment discussion aims to:

  • Engage leaders so they have a common understanding of where the organization is on its journey
  • Provoke thinking and action around the organization’s commitment to zero harm, a culture of safety, and approach to performance improvement
  • Create alignment around a goal of zero harm and focus the direction by which the organization is moving to achieve that aim

Embracing the goal of high reliability

Joint Commission President Mark R. Chassin, MD, and the late Jerod Loeb, MD, began evaluating the attributes of high-reliability organizations such as members of the commercial aviation and nuclear power plant industries many years ago. Drs. Chassin and Loeb also studied the approaches used in manufacturing, and they analyzed the high-reliability characteristics of corporations such as General Electric and Toyota. With the knowledge The Joint Commission gained by surveying more than 20,000 programs and organizations, the high-reliability maturity model for health care was developed, culminating in an article published in 2013 in the Milbank Quarterly.* More than 60 organizations were involved in piloting the assessment, which led to optimization of the questions and the Oro 2.0 application.

Why should surgeons support and champion this cause? First, because surgeons have an opportunity to observe firsthand situations that resulted in preventable harm to patients. The undesirable outcomes of these situations hurt patients and surgeons alike. Second, surgeons are becoming leaders in their organizations to a greater extent than we have seen in the past. Even if we are not leading from a formal position, we often have a great deal of influence in our organizations and, therefore, are in a prime position to recognize that taking on the aim of zero harm is in the best interests of everyone—patients, hospitals, and surgeons.

Embracing high-reliability science is an approach that can lead to dramatic improvements in patient outcomes, health care redesign, organizational effectiveness, and cost. It also can lead to dramatic improvements for the day-to-day work of an individual surgeon in terms of efficiency, empowerment, and the optimal care for all patients.

See more information about Oro 2.0.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily represent the official views of The Joint Commission or the American College of Surgeons.

*Chassin MR, Loeb JM. High-reliability health care: Getting there from here. Milbank Q. 2013;91(3):459-490.

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