Radical transparency: A case study in the application of high reliability organisation principles at a complex Veterans Administration Medical Centre

To enhance the high reliability organisation (HRO) journey and staff psychological safety at the Edward Hines Jr. VA Hospital, the Executive Leadership Team (ELT) created a culture where staff were provided a venue to speak up, and with confidence, without fear of reprisal when challenging leadership and sharing ideas. The results from the most recent All Employee Survey (AES) demonstrated increased employee engagement. The collective commitment led to a significant achievement of a threepoint increase in the best places to work rating. The AES survey also indicated a positive shift in psychological safety, risk identification and just culture, error transparency and risk mitigation, teamwork cohesion and overall staff engagement. Employees identified increased trust in leadership due to increased transparency and communication. An increased sense of diverse viewpoints in decision-making processes and a collective fostering of an environment of diversity, equity and inclusion is evident as fewer Hines team members report feeling discriminated against. Radical transparency has spearheaded efforts in leading culture change, which, in turn, has increased staff psychological safety, retention and patient safety. Leadership at Hines VA has made having the hard conversations comfortable and acceptable ‘the way we work’.