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The Purpose and Goal of This Work Transferring the Aviation Risk Management Model (ARMM) into an Ambulatory Healthcare Organization Proefschrift ter verkrijging van de graad van doctor aan de Universiteit van Tilburg, op gezag van de rector magnificus, prof.dr. Ph. Eijlander, in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie in de Ruth First zaal van de Universiteit op maandag 7 juni 2010 om 14.15 uur door Yosef Tal geboren op 24 maart 1951 in de USSR en om 15.15 uur door Itzchak Lichtenfeld geboren op 3 mei 1951 in Israel. Promotor: Prof. Dr. John B. Rijsman Acknowledgments This work is dedicated to the very special people we met on our professional road, some of them flying airplanes and some of them curing people. We met highly professional and dedicated people willing to fulfill their mission perfectly but without compromising safety. Among these many wonderful people we will just mention a few: Colonel S. from the IAF, Prof. Aviram, Dr. Willff-Meron and Dr. Gindi from Maccabi. This work was absolutely without any chance of becoming real without the inspiration, patience, guidance and faith of Prof. Rijsman to whom we owe the deepest debt and express hereby admiration and gratitude. To our families, for being patient and empathetic, when in a sudden we became students again, this time absolutely committed. Writing this thesis, stressed our personal and professional partnership and companionship. We express hereby gratitude for this rare opportunity to join personalities, attitudes and abilities that are evident in this work. Preface Risk management, from our point of view, has to do with the very core of human existence and beliefs. Being able to manage risks, means that we are not victims of some unknown forces, but rather in control of our lives, reality and fate. A world governed by belief and means to manage risks, is a more optimistic, safe and satisfactory one. In our professional experience, we have witnessed people and organizations, acting in a total disbelief, that things may be controlled and changed for better. We believe, that Risk Management, can serve as a positive organizational drive, based on a deep inquiry of past events, thorough learning of the present and visionary consideration of the future. In most of the cases, Risk Management is approached after all the conventional tools of management bankrupt and the organization is in deep distress. Meeting a successful organization, willing to start Risk Management activity, although rare, is a wonderful opportunity to make real progress in quite a short time. Risk management is a dynamic discipline, which has to adopt itself to the ever changing reality. Practicing the risk management concepts and methodologies of yesterday, poses a serious risk today. Being dogmatic and rigid in analyzing reality is a risk by itself, because of the very dynamic nature of risks. Risks may be considered as a negative potential energy, that has the power to destroy, harm and cause losses. Thus, risks will forever be existent and striving to crystallize themselves in adverse events. We believe, we have proved in this work, that there is a great value of sharing knowledge and adopting knowledge, even when it doesn't seem feasible, like in the case of such remote domains as Aviation and Medicine. While writing this work, we have undergone many professionally maturating changes and have by doing it, actually discovered the Aviation Risk Management Model. This is to say, that whenever you are involved, as a professional, the intervention changes you, your tools and thinking forever. Risk Management in Healthcare, although originated from the first days of medicine, has still a long way to go, to become a fully mature professional discipline. We hope to share our experience and to contribute to its development, from our deepest motivation to save human lives. Yossi Tal and Itzik Lichtenfeld Tel-Aviv, Israel May 2010 Table of Content: Chapter 1 ............................................................................................................. 6 The Purpose and Goal of this Work ............................................................... 6 Why are we writing this book? ......................................................................................... 6 Lots of differences, lots of similarities ............................................................................ 11 The need to share and impact ....................................................................................... 12 Challenges and obstacles ............................................................................................. 14 Beyond business, the origins of our motivations ............................................................ 17 Chapter 2 ........................................................................................................... 19 The rationale for non empiric, experience based research, as a methodology for leading and assessing organizational change ............. 19 The Non empiric experience based research methodology - A personal view ............... 19 The History of Qualitative Research .............................................................................. 21 Types of Qualitative Research ...................................................................................... 26 Assumptions of the Qualitative - Constructivist Research .............................................. 29 Action Research ............................................................................................................ 35 Summary: Thoughts on our study and its linkage to the Qualitative – Constructivist paradigm. ...................................................................................................................... 38 Chapter 3 ........................................................................................................... 43 Safety, Risk Management, Quality improvement Models, Concepts and implementation. ............................................................................................. 43 Prologue – We are now at a different point ................................................................... 43 Major approaches to Risk Management ....................................................................... 44 Safety, Risk Management, Quality Assurance , Similar goals, different approaches .. 49 The History of Risk Management .................................................................................. 52 Pioneering implications of Risk Management ............................................................. 54 Major Milestones in the development of Risk Management Thinking. ............................ 55 What motivates Adopting Risk Management Attitudes and Behaviors .......................... 62 The implications of the current global financial crisis on Risk Management Thinking..... 66 Chapter 4 ........................................................................................................... 71 Aviation and Healthcare ............................................................................... 71 Risk Management – From Aviation to Healthcare: A personal perspective .................... 71 Pilots & Doctors ............................................................................................................. 73 The Pilot ........................................................................................................................ 75 The Doctor .................................................................................................................... 77 Aviation and Healthcare: A Comparison ........................................................................ 79 Summary ....................................................................................................................... 89 Chapter 5 ........................................................................................................... 92 Transferring a model from one content world to another.......................... 92 Introduction ................................................................................................................... 92 The rationale for transferring models ............................................................................. 93 Choosing the right model, choosing the right organization............................................. 94 Establishing the organizational infrastructure for the adaptation of the model – Professionals and Consultants. ..................................................................................... 99 Resistance to Change and practices from other content worlds .................................. 106 1 Chapter 6.1 ...................................................................................................... 113 In search of a model with proven results .................................................. 113 Chapter 6.2 ...................................................................................................... 120 The role of pioneering: What to do without a benchmark in the HealthCare industry? .................................................................................. 120 Redefining the needed model: Proactive RM with proven results. .............................. 120 In case there is no model, is it wise to define one based on personal experience and organizational goals ? ................................................................................................. 123 Many buzzwords,
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