Building High Reliability in Healthcare Organizations through Executive Leadership Coaching

Case Story


Helping the Veterans Health Administration Transform into a High Reliability Organization

The foundation of High Reliability Organizations (HRO) in healthcare relies on leadership commitment, a culture of safety, and continuous process improvement. As a result, HRO enables healthcare organizations to maintain a constant focus on preventing errors to achieve the goal of zero preventable harm. HRO principles originate from high-risk environments such as aviation and nuclear power, and they are increasingly applied in healthcare settings across the nation.

Cognosante supports the Veterans Health Administration (VHA) in its journey to transform culture and operations to become an HRO. One of the largest healthcare systems in the world, the VHA provides patient care to over 9 million beneficiaries through 170 Veterans Affairs Medical Centers (VAMCs), over 1,000 Outpatient Clinics, and 340,000 personnel.

The Challenge

Eliminating Preventable Patient Harm by Applying HRO Principles

The VHA’s HRO journey is a core component of its overall modernization strategy. Healthcare organizations engaged in HRO journeys require active and visible leaders at every level. Leaders can apply a set of research-backed foundational practices that help enact a just culture and drive continuous learning, all with the goal of reducing unwanted variation in care delivery and eliminating preventable patient harm. Like other health systems around the world, VHA challenges in relation to the COVID-19 pandemic provided unprecedented opportunities to apply HRO principles and demonstrate resilience in the face of a national crisis.

To support the VHA’s HRO contract, Cognosante was tasked to work directly with healthcare executives at VAMCs to assist them in tailoring and implementing a set of foundational practices that infuse HRO into daily operations across their facilities.

Coaching for HRO
executive leaders
Training for frontline
and executive staff
Supporting a culture of safety for Veterans’ health

Our Solution

Implementing Leadership Coaching, Change Management Strategies, and Continuous Learning

Cognosante’s executive leadership coaches support VHA leaders in maximizing key strategies to institute safety as a core value of their culture and infuse change management practices to accelerate organizational maturity in complex healthcare environments. Cognosante developed and practices an agile, integrative approach to leader coaching; in which we align our experienced subject matter experts as coaches in large, integrated health systems. Working closely with VHA, we engage with clinical and administrative leaders at all levels within the healthcare setting to empower teams, promote a culture of safety, develop trust, build psychological safety, and embed continuous learning and improvement science into practice. To drive sustained organizational change, we apply Cognosante’s Accelerate, Cultivate, Engage (ACE) model of leader coaching. Our approach leverages best practices across industry, including the Institute for Healthcare Improvement’s Framework for Safe and Reliable Care, a focused leader coach/executive leader matching process, a rigorous coaching certification process, fundamental evidence-based high reliability practices, and an array of key adaptive leadership tools and tactics.

Our Tangible Results

Developing an HRO Methodology Applicable to the Entire Military Health System

As advisors to VHA, Cognosante has significantly accelerated the adoption of HRO principles and foundational practices through mechanisms such as HRO workgroups, leader rounding, and safety huddles. While we continue to deliver on the contract, our team has also guided VHA along their HRO journey by:
  • Virtually training executive leadership teams and staff across 18 Veterans Integrated Services Networks (VISNs) and 139 participating VAMCs on the baseline HRO concepts
  • Producing visually based decision support tools and training resources, including targeted, one-page COVID-19 HRO infographics, quick guides, and short video training segments that feature VA leaders and our team members
  • Coaching organizational leaders to develop, submit, and approve publications, presentations, and training on HRO principles, best practices, and adaptive tools for national audiences
The ultimate intent of this work is to ensure reliably high quality and safe care with a positive patient experience for every patient, every time, across large healthcare systems. Additionally, because our team is led by Veterans and experienced healthcare leaders, our methodology is applicable to VHA and also the wider Military Health System and commercial healthcare organizations.
Cognosante helps healthcare organizations in their pursuit to become High Reliability Organizations.

Contact Us About Our Clinical Performance Solutions

Learn how we help our customers implement HRO principles to achieve the goal of zero preventable harm and to reduce operating costs related to employee turnover.
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