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Designing Reliable Processes

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‘Patients receiving the right care, in the right place, at the right time, every time’ is one way to describe reliability in healthcare services.

Reliable processes are those that we can quantify in terms of how often it is done right. A definition of reliability is:

“The measurable capability of something to perform its intended function in the required time under specified conditions.”
Igor Ushakov, Editor, Handbook of Reliability Engineering

It has many parallels with reducing variation.

How do we design reliable processes? Building reliable processes involves three stages:

1. Common agreement

Building reliable processes should begin with the team agreeing what the right process is. Common agreement about what is right should include the core elements that ensure quality and can be measured. You can include administrative and other support processes, as well as equipment management in the scope of the common agreement.

The following improvement strategies will help:

  • Using process mapping to uncover differences in clinical practice.
  • Protocol-based care is about developing common agreements.
  • Evidence based care bundles – identify core elements of care that are evidence based and measureable – see hints and tips below.

2. Measure how often we currently get it right

Measuring how often a process is done correctly will determine how reliable a process currently is. For example, if your access target is 100% target but you have two breaches out of 100 attendances your reliability would be 98%.

There are four levels of reliability:

Level One: Basic level of reliability (also known as 10-1): This is 80 to 90% success (one or two failures out of 10).
Level Two: Standard level of reliability (also known as 10-2): This is two failures or fewer out of 100 opportunities.
Level Three: High level of reliability (also known as 10-3): This is five failures or fewer out of 1,000 opportunities.
Level 4: Highly reliable (also known as 10-4): This is five failures or fewer out of 10,000 opportunities.

3. Making improvements and measuring them

Ensure that your processes are reliability is not a one-off exercise. You should measure and monitor the reliability of your processes on an ongoing basis.

If you have identified which elements of care are ideal and which can be measured by their reliability, you now need to compare the reliability of what you have measured to the different levels above. It is quite likely that you have found that you have a reliability that is less than 90 per cent. This means that it is unlikely that there is common agreement within the team or across the care pathway about what elements of care are ideal.

Resources

Further information

< Step 3: Plan and implement the changes

< The Improvement Journey