Resilience, Reliability & Results

A “resilient” organization, team, or individual has the ability to bounce back from a hard hit, to deal with adversity and return to a high level of performance. This idea has been gaining prominence in several fields in the last few years. In safety in high-consequence industries (aviation, chemical, nuclear, and healthcare), it means the ability to recover from accidents and also to prevent them before they happen. In human and social development, it means the ability of individuals and communities to rise above their circumstances and better themselves despite misfortunes or difficult conditions. In organizational terms, in means the capacity of a government, healthcare system, or private-sector company to recover from environmental shocks, adapt to the new situation, and return to a well-performing equilibrium point.

Why is resilience an important capacity for organizations, groups, and individuals to develop? In 1988, in a report for the Office of the Auditor General, Federal Government of Canada, Otto Brodtrick wrote:

“Well-performing organizations encourage risk taking. They are willing to try new methods when common sense dictates that better results can be achieved by following the spirit of a regulation, instead of the letter. However, staff must hold the values of stewardship, service and results, and they must consult with each other. When their people are governed by these values, the well-performing organizations encourage risk taking as a matter of strategy.”

Strategic risk-taking and risk management, toward optimizing performance, are hallmarks of the Resilient Organization. Given budget shortfalls, aging populations, and increasing demands for targeted, high-quality services, governments and healthcare systems must develop their capacity for resilience if they hope to accomplish their mandates. The same thing is true, in different ways, for high-consequence industries and the private sector. Achieving good performance in pockets seems more attainable than maintaining and sustaining it over large segments of a system or organization. Building organizational resilience is a necessary performance platform in today’s environment.

This is even more true today than it was ten or twenty years ago. Many governments, hospitals, school boards are facing budget crises and severe fiscal constraints across Canada, Europe, and the U.S. Take the healthcare sector as a further illustration. In many Canadian provinces spending on health care is fast approaching half of the provincial budget and is growing at a rate of 5-8% per annum. This is at the same time as governments are running significant deficits and demand for health services are climbing. This is also at the same time when government should be focusing more of their scare resources on investing for the future. Departments/Ministries of Health and Finance can only meet their fiscal accountabilities if they adopt the Resilient Organization perspective. Otherwise, their strategies will be limited to broad-brush cuts in service which do not change the basic dynamics of the system. Resilience can achieve both: steadily bending the cost curve, while increasing the quality of care and access to service. How? By improving alignment across the sector, enabling organizations to adapt, flex, and anticipate to environmental shocks, and (in general) reducing the costs of coordination by improving system-wide teamwork and situational awareness. All of these are characteristics of a highly-reliable, resilient healthcare system.

There are a number of studies that show that by only focusing on results, organizational improvement is temporary and not embedded in the culture of the organization. Using the same resources, one can focus on creating a resilient organization that will achieve the desired results over the long term.

In a future post I will write about a new paper by some leading US Healthcare thinkers on "Transforming Healthcare: A Safety Imperative". It is a fascinating paper and I think hits the nail on the head in terms of how to transform health care.