The Exec: Arthur Pancioli Focuses on High Reliability at UC Health
By Christopher Cheney
The new chief clinical officer of UC Health is looking forward to helping the academic health system on its journey toward high reliability.
Arthur Pancioli, MD, assumed the role of senior vice president and chief clinical officer at UC Health in August. Prior to taking on his new position, he was chief transformation officer of the health system. He has a clinical background as an emergency medicine physician.
This year, UC Health launched an initiative to become a high reliability organization.
“Many healthcare organizations across the country have taken on the concept of high reliability,” Pancioli says. “It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability.”
The first step in this process, he says, is assessment.
“The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization,” Pancioli says.
“This will require that we truly see a culture shift and a mindset shift and a whole new way of doing things in this organization,” he adds. “When we get it right, we can be what we aspire to be.”
“You must create a culture of psychological safety, and you do that by defining the rules in ways that people understand,” he says. “You highlight the behaviors you hope to see when they are modeled and demonstrated to set expectations. You also need to highlight behaviors that are not OK, and let the staff know how the organization will deal with them.”
To establish a culture of psychological safety, a health system must shift away from a culture of blame and shame, Pancioli explains.
“An individual should not be blamed for an error unless it is volitional,” he says. “Our people are doing complex things, and we need to address systems that set people up for the potential of errors.”
The health system’s leadership team is playing a key role in the high reliability initiative.
“Like any major initiative, it requires abject buy-in from the leadership and a system where the behaviors that you hope percolate throughout the organization are modeled by the leadership,” Pancioli says.
Frontline caregivers will also be crucial to implementing the initiative.
“You must engage frontline workers as subject matter experts and defer to them about the elements of the health system that need change,” Pancioli says. “You can’t do everything from the top down.”
“We have dedicated safety experts at every site of our organization,” Pancioli says. “They are trained in avoiding potential harm to patients. They document near misses and see what we can learn.”
“We have rigorous detection of errors, whether or not there is an impact on patients,” he adds. “When there is an impact on patients from errors, that prompts a root cause analysis by a team using structured methodologies.”
UC Health is working with healthcare technology company symplr to automate the adverse event reporting process. Staff are able to develop adverse event reports through the EHR platform.
“Because it is a standardized program specifically designed for this type of work, it leads us in information gathering,” Pancioli says. “It starts a process to not only examine a singular event but also allows us to aggregate events and look for systemic causes of adverse events.”
UC Health has “myriad triggers” for detecting medical errors and near misses, including staff reporting and patient complaints, according to Pancioli.
“For every reporting agency that we work with such as the Centers for Medicare & Medicaid Services, we have standard reporting of errors,” Pancioli says.
Christopher Cheney is the CMO editor at HealthLeaders.