The components of habit and high reliability
| Component of habit | Organisational examples |
|---|---|
| Tendencies towards modes of action and thought | All caregiver perspectives are valid and useful. Elicit front-line caregiver concerns and recommendations for peers and administrators.4 30–33 Taking the patient perspective in all work activities.29 Standardise as much as possible to preserve attention for noticing and fixing discrepancies.30 31 Reliability falters when thought and action are passive32 33 or self-protective (we are still a centre of excellence) and comfort-centred (we have tough cases; still coming up the learning curve).26–28 |
| Acquired and shaped by prior action | Extensive and ongoing training regarding collaboration (eg, shared language), problem-sensing and using improvement tools.4 29–33 54 Socialising newcomers and otherwise sharing organisational history of challenges and how they were overcome.54 56 |
| Automatic | Use of standards and routines to trigger specific modes of thought and action.4 30 31 Reliability falters when problems are surfaced and immediately scuttled.26–28 Results in the cessation of speaking up.32 33 |
| Fitted to environment | Change thoughts and actions cued in the environment through greater leader presence and leader style and behaviour, onsite immersions in joint problem-solving, and publicising how front-line suggestions are turned into new practices and standards.29–33 Low reliability also cued by a hostile and unsupportive context that undermines efficacy and rewards silence.26–28 57 |
| Socially shared | Shared tools of lean and other forms of process improvement (eg, Define, Measure, Analyze, Improve, and Control (DMAIC)) throughout the organisation.29–31 Collaborative practice (eg, rounding, formal empowerment and inclusive of post-event debriefs).32 33 Diverse improvement teams that cut across the organisation. Formal ways of disseminating better practice (eg, Armstrong Institute)30 31 |