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Michigan Medicine

A Minute with Marschall

Connecting the Dots: HRO & Engagement

February 17th, 2020
Michigan Medicine employees attend High Reliability Training

Without a doubt, we are all challenged with balancing our responsibilities while trying to make the best use of our time. Whether we serve as faculty, administrators or support staff, adding more to our plates, like additional training, can feel overwhelming at times.

Our third and fourth quarters seem particularly busy. Everyone is expected to complete Universal Skills training by this June to support our journey to become a Highly Reliable Organization (HRO). At the same time, we are focused on employee engagement in the hopes of seeing improved survey results with this year’s survey in April. While they may feel like distinct initiatives, both efforts are driving to the same positive outcome – a cultural change which will lead to a safer, more efficient and respectful environment for us, our patients and their families.

There’s a clear connection between our HRO and engagement efforts. HRO’s goal is to improve safety by teaching people the skills that will reduce preventable error and optimize our tools and work flows.  The engagement survey identified communication and professional development as institutional opportunities for us.

HRO teaches us that speaking up and increasing our communication with colleagues helps us avoid mistakes and near misses. Creating more opportunities for dialogue and problem solving, through huddles, rounding and clarifying questions, improve feedback and engagement. Similarly, we can view the Universal Skills training as a development opportunity for all of us, regardless of our functional area. Truly practicing the Universal Skills requires behavioral change and leadership support, which is only achieved with engaged employees. Both cannot succeed without true cultural change. 

So instead of us looking at these as two separate, time consuming activities, let’s consider them as a shared responsibility to engage each other in improving our workplace culture, and providing the best possible care for our patients.

I encourage you to learn more about Employee Engagement and High Reliability.

Engagement and HRO focus on many cultural attributes, such as trust, accountability, empowerment and mutual respect. What is working in your area to move the needle?  Please share your comments below.


  • What is working at Livonia Surgical Center is the daily Safety Huddle initiated by Adam Gunckle. It provides us the opportunity to learn from past events and to be prepared for the days possible issues. I find educational and an opportunity to connect with other departments on how we can all improve patient safety as a single team instead of individual departments.
    Thanks to the complete “buy in” of LSC Staff there is never any finger pointing or blame, just honest discussion on how we can continuously improve our processes to improve patient and staff safety.
    I would hope other sites will roll out this program and “buy in” to all the benefits the program has to offer.

    • Thank you, Brian and Adam, for living the principles of High Reliability. It not only shows that when everyone adopts HRO into the team culture, it not only helps keep patients, family and staff safe, but it also further connects your team with each other and the mission of Michigan Medicine. As a result, you all become more engaged in your work. Keep up the great work, LSC!

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