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High Reliability Healthcare

Data Driven Insights and Aha Moments in the Pursuit of Zero Harm and High Reliability Healthcare.

Getting an ROI from Robust Process Improvement (RPI)


GrazmanBy David Grazman, PhD
Director - Center Business Development
Joint Commission Center for Transforming Healthcare

As a growing number of health care organizations make progress on their own journeys toward zero harm and high reliability, our Center team frequently hears from organizations struggling with how to bring their leadership fully on board with high reliability or challenged by making safety culture survey results actionable every day. 

It’s a reasonable question. According to a 2013 article in the Journal of Patient Safety, less than 1% of published articles contain substantial cost or outcomes related to investment in quality improvement. 

Reducing Error, Saving Millions
The return on investment (ROI) from preventing errors or harm from happening in the first place can be clearly demonstrated on a project-by-project basis, and at an organization or system-level when the right infrastructure is in place. I discussed this more in a podcast, The ROI of RPI.

Ten years ago, the Joint Commission embarked on its own RPI journey — believing our business processes would be improved by adopting these tools and building an improvement culture. We built our own training program and have trained close to 70% of our work force in RPI. The higher quality, fewer defects and less rework that we’ve experienced as a result of utilizing RPI in our daily work has yielded a 2:1 return on our investment. 

Our results mirror what we’re learning about how RPI is used in some health care organizations. At Mount Sinai Medical Center in New York, the use of RPI tools exposed billing issues with:

  • cardiac stents

  • pacemakers

  • implantable devices

A multidisciplinary team used RPI at another organization to redesign their process, bringing the error rate from 63 percent to 5.6 percent, which translated into $5 million in additional revenue. Another health care system attributes their ability to reduce all harm in their organization by 50% to their adoption of Robust Process Improvement® as the way that they collectively improve how they work. We’ve seen projects with similar results focused on challenges including:

  • surgical site infections

  • supply chain issues

  • staffing improvements 

While adopting RPI and the establishment of an improvement culture takes time, effort, and dedication, its ROI is hard to argue against. Every process — quality, business or otherwise — can be improved by removing waste and improving quality, and organizations who’ve adopted RPI as their improvement methodology are also reporting:

  • increased morale

  • higher staff retention

  • enhanced safety culture 

  • a virtuous cycle of engagement as a result of the voices of patients and staff are both heard and acted upon

High Reliability Framework
While it does save money, Robust Process Improvement® is really about achieving zero harm.

High reliability relies equally on:

  • Leadership commitment

  • Safety culture

  • Robust Process Improvement® (RPI)®

Over the coming months, we’ll highlight successes those “on the journey” are experiencing as they make progress on these.  

If we’re discussing return on investment, let’s narrow our focus to Robust Process Improvement (RPI) — the last domain of the high reliability model. It is fundamental to progressing towards zero harm and continues to be a major focus of the Center’s work. In fact, the Center’s Targeted Solutions Tools, which are used by almost 1,000 organizations, are built on the RPI methodologies of:

  • lean

  • Six Sigma

  • change management 

Organizations that use the TST® continue to demonstrate that RPI tools and methods can drive substantial improvements to some of health care’s most pressing challenges — hand hygiene compliance and preventing falls among them. RPI is the most effective approach we’ve seen to help health care organizations reach zero harm because it:

  • looks for the root causes to the specific issue at hand

  • targets particular solutions 

  • ensures sustainability over time

Looking for ways to enhance your organization’s approach to improvement? We can help. Contact us by email at or 630-792-5471.

Watch this space. 


David Grazman, PhD, business development director at The Joint Commission Center for Transforming Healthcare, has more than 15 years’ experience leading structured change systems. He has served numerous hospitals and health systems as a consultant, educator and facilitator on a host of issues ranging from corporate and divisional strategy and planning, to improving clinical operations, quality and patient flow across the care continuum, to educating on health care industry trends and public policy.