Accenture and the American Hospital Association (AHA) explore agile innovation in this virtual executive dialogue with healthcare luminaries from across the United States.

Reimagining the high-reliability organization

While the COVID pandemic highlighted the importance of key principles of high-reliability organizations, including teamwork and communication, transparency and identifying bright spots and scaling them, healthcare providers also faced novel situations in which they couldn’t rely on previous experiences and protocols. Simply applying rules didn’t work. An iterative or test-and-learn management approach helped providers navigate the unknown — introducing something new into the system, seeing the response and then changing.

Hospital leaders participating in a virtual executive dialogue examined how to reconcile the cultural shift between incremental change and the need for high reliability with the need for adopting new ways of operating with artificial intelligence (AI) and machine learning (ML) as partners to individualize the patient experience.

Adopting high-reliability principles

Hospitals and health systems have implemented the principles of high reliability to identify gaps in communication and prevent adverse events, which prepared organizations to operate effectively and meet many challenges of the COVID-19 pandemic.

Most hospitals and health systems approach their operations with high-reliability principles, such as reducing variation and eliminating error or failure, even if they don’t explicitly use the term. Some are using robust reporting systems that report incidents at the medical staff committee level as well as departmental levels. Those failures go directly into prioritizing and identifying opportunities for improvement. Others have focused on culture and establishing proper governance, communication practices and creating safety programs.

"We’re going to see emerging work experiences where a human and a technology [AI] work together in a dyad... The challenge is that this technology is, by its nature, not static. It keeps changing over time."

— Kaveh Safavi, M.D., J.D.

Test and learn

Hospitals have to constantly adapt to rapid change. High reliability, however, assumes that teams can rely upon rules and protocols. In uncertain environments and novel situations, a different type of approach may be beneficial. Specifically, an agile or test-and-learn management approach allows teams to test new processes and protocols.

The management model called test and learn has been around for a couple of decades and its methodology came out of complex adaptive systems. Complex adaptive systems think about problems from the spectrum of either known or unknown problems. Known problems typically are addressed simply by applying rules. However, there are two kinds of unknown problems: one is the known unknown, usually a forecasting or a predictive problem, and then, there’s the unknown unknown, where the best management approach is a test-and-learn approach. When the organization doesn’t have a historical understanding of the system to model, it can introduce something new into the system to see the response, and then change. What has been driving the most recent conversations is the rapid introduction of technology and AI into healthcare. Work experiences where a human and a technology work together are emerging. The technology is taking over services that don’t need the judgment of the human being. The challenge is that this technology is, by its nature, not static. It keeps changing over time.

Kaveh Safavi

Senior Managing Director – Consulting, Global Health


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