High reliability, accepting failure and the road to compliance

There is no easy route to success when it comes to achieving compliance in aged care and it’s certainly not for the lack of trying. Compliance is often hard to achieve because of outdated systems and structures that are not fit for purpose, while the unpredictable nature of care means even the best-laid plans may go awry. 

For some, the quality and safety compliance journey hasn’t seen them take the high road, but rather a high reliability approach. Filomena Ciavarella, Executive General Manager, Strategy, at Regis Aged Care has used this approach to develop a continuous improvement culture. 

She sat down with hello leaders at this year’s ACCPA National Conference in Adelaide and shared her learnings with us.

What is high reliability?

“High reliability may seem like another buzzword but it is about how can we deliver more consistent care by implementing key principles into how we work. Within that is an understanding of how humans work,” Ms Ciavarella explained.

“It’s not easy because we work in a complex system and high reliability recognises the complexity of the system. It’s just a different way of thinking about errors and how you can turn errors into something positive to influence and prevent harm from occurring down the track.”

• High reliability is all about recognising that risk and failure can co-exist with effectiveness and excellence
• The approach provides a deeper understanding of why things happen and the actions required to proactively address the causes
• Ms Ciavarella outlined five ‘domains for change’ as their driving forces: leadership commitment to high quality, safe care; a data-driven approach’ standardising the safety operating system; enabling staff to improve; and targeting interventions to address safety issues

The journey to change improvement has included success and some failure for Regis Aged Care. Leadership and culture have been central and leadership buy-in has been particularly important in implementing high reliability. So to achieve a quality and safety culture, Ms Ciavarella said leaders – and staff – need to be empowered and educated on the goals that need to be reached so they can personally buy in. 

“The first thing to understand are the outcomes you’re trying to achieve. Compliance, governance requirements, and keeping residents happy and safe should all be outcomes of delivering great care,” Ms Ciavarella explained.

“We started our journey by defining who we are, what we were trying to achieve and what culture is important to us. And then making sure we have leadership practices and principles in place to help support that culture of care.”

There is no blueprint for change

High reliability requires impactful data collection and analysis plus effective systems that can identify and help resolve issues. Implementing new systems and applications requires a deliberate strategy to guide transformation, however, there is no blueprint for change. 

This means you do have to look within for answers and also to other organisations and sectors for ideas. You may have to reframe your thinking and how to deliver on your goals.

At Regis Aged Care, Ms Ciavarella explained how they identified gaps where improvements could be made which resulted in the introduction of statistical process control charts into governance reporting, plus new systems like an incident severity matrix, root cause analysis methodology and a Clinical Incident Review Committee.

Each system and framework is designed to have an impact on quality and safety at a deep level, rather than just identifying issues after the fact for reporting’s sake. Ms Ciavarella likened the overall impact to removing mosquitoes from a swamp. You can swat them one by one but the only way to truly get rid of the problem is by draining the swamp.

“What are the underlying triggers causing incidents or failure points? How do you get to the bottom of what the swamp is and what do you need to do to drain the swamp,” she added. 

Introducing several new systems can be daunting and there is a need to understand and display the data in meaningful and impactful ways once done. It’s why effective training has been implemented to ensure every single employee understands how to work efficiently with a culture of care. This methodology has enabled improvement and created what Ms Ciavarella calls “9000 change agents” at Regis Aged Care.

“A really important part of a quality and safety culture is to enable your staff to be change agents and give them the skills, tools and authority to make those thoughtful changes. There are principles around human error, systems thinking, how to improve, and so by giving your staff and leaders those tools and skills, you enable them to succeed and thrive,” Ms Ciavarella said.

Vulnerability and failure are part of the process

High reliability is underpinned by the acceptance of failure and its benefits as a learning tool. With this comes a need to be vulnerable, open to feedback and mistakes, and a willingness to be transparent when implementing change. Ms Ciavarella said their leadership teams have benefited from the open-minded approach when things go wrong.

“As leaders you could fall into the trap and say ‘Well, this should be done and why isn’t it being done’ and you can quickly go to blame. It’s really important to take a step back and say ‘How did these systems allow this error to occur, where am I accountable and how can we help our teams to succeed’,” she explained.

“Being open and transparent about mistakes, errors, failures and partnering with your teams on the ground to understand why something went wrong.”

In the pursuit of improvement, you must always recognise achievements because there will be mistakes. You may introduce software that’s not fit for purpose or implement an incident reporting framework missing some key processes. These moments are worth analysing and learning from, but not lambasting or lingering on.

“Have a bit of a mantra of ‘Let’s try’. It doesn’t have to be transformational, it can be one incremental step in the right direction but it’s one step further forward than where you were yesterday. Even if we don’t get that step right, if we learn from that, that enables us to take a bigger and better step next time,” Ms Ciavarella said.