High-Reliability Organizational Concepts: Insights of Value to any Dental Practice

What can dental practices learn from high-risk industries?

July 30, 2018
Trude Henderson

When we think of a place where miracles happen every day, where the highest focus, safety and consistency are absolutely critical, what scenes first come to mind? A surgical suite at a children’s hospital, the control room of a nuclear-powered submarine, or the busiest airport in the world? The industries that first initiated the use of High-Reliability Organization (HRO) concepts included the aviation, nuclear power, manufacturing and military sectors.
Few organizations are as at-risk or mistake prone as these, but the principles underlying the success of HROs offer insights that can prove invaluable to you, the dental practice leader. A skeptic might respond, “You’re putting dental organizations in the same league as those other ones? Isn’t that comparing apples to oranges?” The answer might surprise you. HROs are adept at hard-wiring certain valuable behavioral traits into any organizational culture, with the potential to mitigate adverse or threatening effects. Please allow me to explain how these insights can be beneficial to your dental practice improvement strategy.
Let’s begin by defining what an HRO is: an organization that conducts relatively error-free operations over a long period of time, making consistently good decisions that result in high quality and reliable operations.” 
Don’t you want your dental practice to be such an organization?
Below are some key takeaways that can help you obtain superior performance at every level of your organization:

1. HROs maintain a keen awareness, a “sensitivity to operations” and systems. They pay close attention to what is and what is not working. They know if they are winning or losing at any given moment. Decision-making and operational initiatives are based on information obtained via observation, surveys and other metrics. And they take action to prevent errors.
   1. Transparency and trust go hand-in-hand. People who are generally open and honest inspire greater esteem and confidence than others. The same applies to dental practice leaders and employees, both.
   2. Dental practice leaders that encourage transparency usually have higher-performing teams than those that do not. To quote Peter Drucker: “What gets measured gets improved.”
   3. Remaining mindful of where you are now and where you want to be helps you fill in the gaps, increasing the likelihood that you will achieve your goals. Tip: put dental practice metrics in front of your staff every day. Challenge the team to openly discuss ideas for improvement.
   4. Continuous feedback can result in better decision-making because it helps dental practices learn more, improve their processes in real-time and reduce inconsistencies.
   5. Big data, identified, analyzed and distributed appropriately, can be transformative, ultimately making a positive impact on day-to-day operations. 
2. HROs resist the temptation to accept ‘simple’ explanations for problems. They ask a lot of questions and challenge long-held beliefs, potentially resulting in improved source identification and understanding underlying causes.
   1. Dental practice leaders should strive to provide a safe, open environment where their employees feel free to express their ideas and concerns. Albert Einstein defined insanity as “doing the same thing over and over again and expecting different results.”
   2. Ask “why” as many times as necessary to get to the bottom of any issue. We covered this in more depth one of our previous blogs. Check it out!
   3. Encourage employees to search for ‘blind-spots’ and challenge ‘phantom-rules’ (long-held organizational beliefs) that serve to maintain the status quo, and commonly prevent dental practice improvement strategies from even getting off of the ground.
3. HROs are “preoccupied with failure.” Employees at all levels are encouraged to ponder the types of problems that might result in work processes breaking down, slowing down or becoming dysfunctional. In addition, they routinely share their concerns and become involved in developing best practices across departments. Furthermore, they are deeply concerned about complacency, routine and lack of engagement.
   1. Dental practice leaders should seek to de-stigmatize failure by communicating the importance of viewing challenges and negative feedback as opportunities for improvement. The best leaders and employees remain calm, focused and on point when faced with the toughest challenges. Be sure to set the example and reward such behaviors!
   2. Dental practice leaders should provide frequent opportunities for meaningful conversations and collaboration. Sharing ideas gives your employees a sense of purpose, while providing mutual benefits to the practice and the team.
   3. Ensure that proactive behavior is fully understood and implemented. Settling for less can result in demonstrably negative consequences for employees, patients, budgets and practices alike.
   4. Taking proactive steps, such as anticipating the needs of patients, can provide a customized, more personalized experience, setting your practice apart from the pack.
4. HROs “defer to expertise.” Leaders push decision making to the front lines and genuinely listen to people equipped with the most knowledge and experience regarding the task at hand, regardless of their title or status. They encourage conversations and problem-solving in the work area, as opposed to the occasional conference room meeting.
   1. Try to discuss and resolve issues on-the-spot, rather than waiting for the occasional conference room meeting, but make sure that your conversations are out of earshot of your patients. In his January 19, 2018 blog titled, ‘Wow’ customer service for dentists: a competitive advantage” Roger P. Levin, DDS said: “Create a culture of excellent customer service among the staff—Talk about it every morning in your daily business meeting, refer to it throughout the day, and celebrate wins.” We wholeheartedly agree and would add the following: From our experience, skipping the 10-minute daily huddle can be a sure way to demotivate your dental team and de-rail your practice improvement strategy. If you want employee commitment, don’t cut corners here.
   2. Level the playing field so that more people are included in the problem-solving process, thus generating ‘real impact.’ Said Ray Lewis, “Greatness is a lot of small things done well.”
   3. Draw on experts to solve problems. Research indicates that experts can better understand problems and identify trends and meaningful patterns.
   4. Establish strong and diverse partner ecosystems, comprised of employees, patients and partners. Research reveals that high-performing organizations prioritize people and form robust partnerships.)
5.  HROs “are resilient.” They relentlessly stay the course, never abandoning the continuous improvement process, always seeking for better, more efficient ways of doing business. They are efficient problem-solvers and continuous learners.
   1. Be a leader and a pioneer. Don’t be afraid of change or a challenge. John Quincy Adams said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” 
   2. When hiring and promoting dental employees, look for people who appear resilient in confronting obstacles. Resilient employees can help inspire others to remain calm and stay the course during stressful or tough times. They can be your best cheerleaders!
   3. Never stop learning as an organization. Most employees want to learn and grow, and as the world continues to evolve technologically, it is indispensable to the growth and profitability of your dental practice. The alternative to a learning culture is a static one that mindlessly repeats mistakes and suffers from high turnover, due to employees who are present in body but not mind.
   4. Say ‘Thank you’ often because it can help foster resilience. Employees who feel appreciated are more likely to endure the bumps in the road and continue moving forward. Employee energy, both positive and negative, can directly impact patients. Happy people equals happy, loyal patients!

To conclude: High-Reliability Organizations have a sense of purpose, and they understand that the right behaviors drive long-term excellence and sustainable results. More specifically, the results suggest that these high-performing organizations offer a plethora of valuable insights to dental practices wishing to consistently accomplish their goals, avoid errors and keep their practice improvement strategy on track.





Read my other articles on topics such as Leadership, Operational Excellence and High-Reliability Concepts:
Ten Steps You Can Take Right Away to Improve the Reliability of Your Dental Practice
Trude Henderson is the co-founder of ToothFairy, a startup elective dental and medical practice improvement software company which delivers an unparalleled customer experience that inspires delight, loyalty and positive emotional connections to improve the lives of patients and the practices they visit. In 2016, she was the first to introduce High-Reliability Organizational Concepts to the dental industry. For questions, contact her directly at Trude@GetToothFairy.com. Follow Trude on LinkedIn:  https://www.linkedin.com/in/trudehenderson/ (no email required).
Go to ToothFairy's website: www.ToothFairySoftware.com.