Healthcare HROs Unlocked: Part 2

As a continuation of Part 1 of our Healthcare HROs Unlocked series, we will begin to deep dive into specific aspects of High Reliability Organizations. In the study, Managing the Unexpected, Karl Weick and Kathleen Sutcliffe defined an HRO as an organization that functions in a complex and hazardous environment with a rate of mishap and error much lower that expected (Weick & Sutcliffe, 2001). HRO organizations are not so risk adverse that they attempt to be error free, but they are so risk aware, they can anticipate when there is potential for error and when it occurs. HROs can recover quickly based on training and a proactive position geared towards containment. Furthermore, the best HROs are taking this a step further by addressing the errors that occurred by deep diving into the situation, evolution, or procedure, to find what caused the error, when the error occurred, where the error occurred, how the error occurred, and often who caused the error.


At this point, I would caution the readers to understand, that the “WHO”, does not necessarily mean a specific individual, but the source of the error from a human factor’s standpoint (there will be more regarding this point later in the series). 


In preparation of evaluating the ability to become or achieve a High Reliability Organization culture, an organization must consider certain principles that help define HROs. The most commonly held principles of HROs are:


Principles of High Reliability Organizations
Principles of Anticipation: Principles of Containment:
1.     Preoccupation with Failure and It’s Causes 1.     Commitment to Resilience
2.     Reluctance to Simply Interpretations 2.     Deference to Expertise
3.     Sensitivity to Operations

(Gillingham, Corbridge, Warner, Shaub, Hoffman, 2016)


Many healthcare organizations have made great strides in an effort to become an HRO, with improved education and continued training, at both educational institutions training new medical staffs and administrators, and regular refresher training at healthcare facilities. The principles of High Reliability Organizations can transform one’s healthcare facility to a highly resilient, proactive healthcare organization that can recover from the inevitable errors that will take place; whether through complacency, human error, mechanical error, or simple negligence. In the third part of the series, COORS will begin to break down the first principle, Preoccupation with Failure and It’s Causes.



  1. Karl Weick and Karen Sutcliffe, Managing the Unexpected: Assuring High Performance in an Age of Complexity (San Francisco: Jossey-Bass, 2001).
  2. RDML Bruce Gillingham, (MD), MC, USN; LT Joshua Corbridge, MSC, USN; CAPT Howard Warner III, USN; CAPT (ret) Curtis Shaub, USN; LCDR (ret) Richard Hoffman, (Ed. D), USN; High Reliability Health Care: Lessons From the Fleet (May 2016)


About the Author:

LCDR Stephen J. Hartz, MS, MBA, CBA is currently serving within the Directorate for Integrated Warfare and is in the process of retiring from the Navy after 20 years of service.  He is a qualified Combat Helicopter Pilot and Surface Warfare Officer. Steve has spent much of his military career learning and teaching risk mitigation and resource management at every level, to include being an honors graduate of the Naval Aviation Safety School, a squadron Aviation Safety Officer, and Safety Officer of the east coast Helicopter Fleet Replacement Squadron. Steve holds his PMP and LSSGB certifications. Steve’s last active duty flying assignment was as the Officer-in-Charge of the Whidbey Island Search and Rescue Unit, the Department of Defenses number one Search and Rescue Unit in the world, conducting over 70 real world complex rescues a year, including dozens of trauma one medical rescues within the Cascade and Olympic mountain ranges.

Congratulations to Trina D. Abla, DO, Chief Medical Officer of Mercy Catholic Medical Center at Trinity Health Mid-Atlantic

Congratulations to Trina D. Abla, DO, who has been named the Chief Medical Officer of Mercy Catholic Medical Center at Trinity Health Mid-Atlantic.  MCMC comprises Mercy Fitzgerald Hospital, serving suburban and urban patients of Eastern Delaware County and South Philadelphia and Mercy Philadelphia Hospital, serving the urban population of West Philadelphia.  Dr. Abla was previously the Chief Quality Officer and Associate Chief Medical Officer at Penn State Health Saint Joseph in Reading, PA. In her new role, she will engage and integrate with the Executive team and Medical Staff to champion and advance the strategies of the organization, fulfilling their mission and responsibilities to the patients and the community for quality, cost-effective care, and positive patient experience.


Best wishes on your new position from Coors Leadership Capital!


Trina D. Abla CMO Mercy Catholic Medical Center at Trinity Health Mid-Atlantic

COORS Leadership proudly announces new CEO placement!

COORS Leadership Capital proudly announces Charles Hall as Superintendent and Chief Executive Officer at Island Hospital.  Located in Anacortes, WA, Island Hospital is an award-winning 43-bed rural, not for profit, district hospital supported by over 190 physicians and healthcare providers.  With over 24 years of operational healthcare experience, Charles will now direct the mission, vision, culture and values of Island promoting excellence, accountability and focus on superb patient care while forging strong ties to the community. Prior to accepting his new position, Charles served as the interim Chief Executive Officer at Alliance Health Durant & Madill in Oklahoma.  Congratulations and Best Wishes on your new position from Coors! For more information, check out the link below!

Charles T. Hall CEO Island Hospital
Continued Relevance, Value and Complexity of Service Lines

Continued Relevance, Value and Complexity of Service Lines

The shift towards alternative payment models has illuminated the necessity for healthcare leaders to re-evaluate the strategic importance of clinical service lines. Across the industry, executives are asking similar questions: how should we align service lines to support shifts in site-of-care and advancement of goals, what is the optimal structure and how do we cultivate dyads leadership models to support cross functional collaboration, and how do we prioritize service offerings to ensure quality and financial solvency.


While there are many points of discussion and opinions, the following abbreviated case studies highlight both the value and complexities of service line rationalization and alignment to support strategic prioritization.


Service Line Rationalization

A service line portfolio review is a valuable endeavor to support leaders in making informed decision regarding the elimination of services that are, redundant, low volume, lack local demand or have a negative net margin, while ensuring the medical needs of a community are met.


ACS Verified Level-II Trauma Center, Hold or Fold?

A 475-bed community hospital located in the mid-West had been operating a well-established ACS verified Level-II Trauma Center for more than two decades. The leadership team debated the financial feasibility and relevance of continuing as a Level-II Trauma Center with regard to the high cost associated with specialty call pay, staffing requirements to support the program, and degree of market saturation within the catchment area.  In consultation with the leadership team, we conducted a comprehensive review and modeled three scenarios: (1) continue as a Level II Trauma Center, (2) downgrade to a Level III Trauma Center, or (3) close the Trauma Program, and evaluated the impact of each decision on the community at large.

Highlights and final recommendation from the Trauma Service Line assessment were as follows:

  • The data showed a steady, positive trend in patient volume, year over year.
  • While the program yielded a net positive contribution margin, it was slim. However, opportunities were identified to optimize the financial performance by improving the billing workflow and revising specialty call coverage.
  • The program had excellent patient care statistics based on positive TQIP results and a recently implemented fracture protocol resulted in a decrease hospital length of stay from 4.5 days to 4 days.
  • A market review of the competitive landscape would most certainly have yielded an organic shift of patients to the nearest higher level of care, should the decision be made to downgrade the program to a Level-III Trauma Center.
  • Despite perceived market saturation, analysis of the catchment area supported the value and community need to continue trauma.

Based on the finding of the Trauma Service Line rationalization assessment, the unequivocal recommendation was to maintain their ACS-verified Level-II Trauma center designation.


Aligning Service Lines to Advance Strategic Goals

Historically, healthcare leaders have focused on revenue generating service lines, such as Orthopedics and Cardiology, to financially sustain their organizations in the fee for service environment. As the industry is rapidly evolving towards cost transformation, many organizations are viewing the emergence of service lines, such as Geriatrics and Primary Care, as a necessary model for advancing goals of strategic importance.


Geriatric Consult Program in the Emergency Department

A large healthcare system located in the Northeast, strived to decrease unnecessary hospital admission/re-admission rates, among other initiatives. They instituted a Geriatric Consult program in three emergency departments serving a dense geriatric population. The program was led by a board certified Geriatrician and designed with the following characteristics and results.

  • A screening process was instituted for high risk patients.
  • The EDs were staffed with Geriatric APRNs, with backup from Geriatrician.
  • Geriatric consults are billable, maintaining budget neutrality.
  • Realized a decreased ED recidivism by 3-7%.
  • >60% of patients evaluated had no need for hospitalization.
  • 85% of patients had changes with medication reconciliation.


Marcia Messer MBA, MHA

Healthcare Executive Consultant

Marcia Messer MBA, MHA



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Healthcare HROs Unlocked: Part 1

There have been many initiatives over the last several decades to improve an organization’s efficiency and effectiveness.  Few have achieved actual results and even fewer have been tested in the most difficult situations.  The United States Navy has lived and proven the results of HRO for the better part of 30 years.

How Artificial Intelligence May Help Diagnose Disease

One of the most potent weapons available to doctors and patients when fighting disease is time. When it comes to conditions like cancer, stroke, or diabetic retinopathy, the earlier they are diagnosed, the better the chances for successful treatment. New diagnostic tools incorporating artificial intelligence are currently being developed that may help doctors in different specialties make more accurate diagnoses more quickly

How to Create Highly-Effective Risk Mitigation Strategies

Whether you’re a private practice or a large hospital, risk mitigation should be an integral part of the of the organizational process. While many organizations have emergency plans to handle obvious risks, it’s important to think about risk very broadly: risks can be anything that causes you to lose revenue (both current and potential).

HROs: Creating the Gold Standard

As the political landscape and patient expectations continue to change, committing to processes that concentrate on superior care and risk mitigation is critical. Maintaining Highly Reliable Organization (HRO) status is not only a goal for healthcare organizations, it’s required for sustaining competitiveness.

Organizations that are renowned for upholding this gold standard almost always have commonalities in how they approach their processes. Here are some traits we find in the most successful HROs:

Benefits of Emotional Intelligence in Healthcare Leadership

As the expectations of quality healthcare change, progressive leaders are now looking beyond the traditionally myopic patient-care standards to provide a holistic approach to patient outcomes. This approach considers not only the patient’s state of well being, but also the care provider. Emotional intelligence (EQ) is the ability to use one’s own emotions to positively manage high-stress situations and overcome challenges. For medical professionals, this can translate into the ability to better communicate and empathize with their patients and coworkers, as well as harness their internal stress and approach problems with a clear, open mind.

High-Tech Healthcare: Trends For 2018

Leveraging innovative technology has become more of a requirement for healthcare organizations to remain competitive with patient expectations. As healthcare IT continues to rapidly advance, identifying a solution that adds value and drives profit can be a daunting task, not to mention the hassle of transitioning internal processes.

As we head into the new year, let’s take a look at a few trends that we expect to shape the way we approach, and manage patient care.