Where Rubber Meets the Road: Accelerating High Reliability with the HRO Optimization Model

The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, providing care at 1,380 facilities, including 170 VA Medical Centers and 1,193 outpatient sites, to over 9.1 million veterans. VHA is on a high reliability organization (HRO) transformation journey, formally initiated in 2019, across its central office, regional networks and facilities. To support the advancement of HRO maturity, VHA implemented an HRO Assessment and Planning process to gauge progress in key HRO practices and behaviors.

This session focuses on the development of an innovative self-guided optimization tool called the HRO Optimization Model (OM). The HRO OM serves as a framework to enhance HRO activities by providing a checklist of actions, resources, templates and examples. Organizations can utilize this framework to advance their HRO practices and monitor their adoption. Additionally, the HRO OM enables leaders and staff to track HRO progress using measurable outcomes. Initially created as a proof of concept based on the Truman VA Medical Center’s HRO approach, the HRO OM was tested through virtual and onsite assessments at 32 VHA facilities across 11 Veteran Integrated Service Networks (VISNs) from 2021 to 2025.

As the HRO OM evolved, it became a valuable, self-guided resource that is actionable for users. This session will outline the tool's evolution, critical decision points, lessons learned and enhancements, including its applicability to other healthcare systems. Key features of the HRO OM, the VHA Maturity Matrix, and the HRO Assessment and Planning process will also be discussed. The session will emphasize how the HRO OM provides practical guidance and a roadmap for implementing, sustaining, disseminating and optimizing high-reliability practices. It will also illustrate how it captures the cause-and-effect relationships of applying HRO principles to achieve results, highlighting the value of facilitating organizational reflection and collaboration through the VHA HRO assessment and maturity analysis processes. In addition, national, regional and healthcare system experiences with the process would be highlighted during the presentation.