How Beautiful Questions and HRO Principles Enhance Patient Safety

Jeffrey Oliver, Lt. Col., (Ret.), CCNS, CNOR, Clinical Support Specialist at LiveData

Healthcare often seems like a volume game. How many patients can a doctor see? How long can be spent with each one? How many operations can be performed, or how quickly can beds be turned? There are very slim margins — and most decisions are data-driven. But what if there’s more to it?

If we ask the right questions that challenge current norms and combine those answers with what we learn from analytics, we can identify root causes, address practices, and adjust routines — even in small ways. Doing so will allow us to fundamentally change healthcare systems, deliver better patient care, and fully optimize existing resources.

The Role of Beautiful Questions

Even as a conservative industry, it is time to move beyond fears, biases, and the limitations present in healthcare today. It is necessary to scratch below the surface to avoid getting stuck in “That’s just the protocol.” Don’t get me wrong, protocols exist for very important reasons, but healthcare is not one-size-fits-all. As much as we can predict, given all the data at our disposal, things still go wrong. Bodies don’t always behave the way they’re supposed to. Surgeries take longer than expected. Decisions must be made in a split second, and scenarios may not follow guidelines.

As such, we should encourage healthcare professionals to adopt an inquisitive and open-minded approach to care, one that doesn’t shy away from flaws in the system but rather looks for opportunities to improve. This mindset shift is essential for fostering a culture of creative problem-solving, continuous improvement, and innovation in healthcare settings.

Let’s take a simple yet common example. If a hospital sees a high rate of readmissions for patients with a certain procedure, it’s important to look at why that’s happening so that it can be addressed rather than allowed to recur. Readmits are bad for patients and hospitals, driving up costs and exposing each to unnecessary risk. In this case, physicians or administrators must ask the question, “What factors contribute to readmission?” It could be a flaw in the procedure itself or something as minor as inadequate discharge planning. But the team won’t know unless they ask the question and delve into each piece of the patient puzzle.

Using Such Questions – Along With HRO Principles – to Enhance Patient Safety

To implement these beautiful questions, organizations can learn from other segments — high reliability organizations (HROs), to be exact. Rooted in industries like aviation and nuclear power, HROs are structured to function effectively in complex, high-risk environments while still focusing on safety.

They do this by constantly anticipating potential failures and accounting for them. In the case of healthcare, it might mean looking for risks in the surgical suite, like ensuring all of the necessary equipment is there and in working order or clearly delegating responsibilities and determining how to mitigate any potential human errors.

Another important lesson that can be drawn from HROs is valuing the diverse perspectives assigned to a case, whether it’s the surgeon, anesthesiologist, nurse, or technician. Valuing each individual’s expertise can help prevent critical incidents.

But to ensure that individuals feel comfortable speaking up, such as a junior nurse questioning a surgeon, there has to be a psychologically safe environment in place. This is a priority of HROs. Staff must feel secure in voicing concerns, asking questions, and challenging processes without fear of retribution or embarrassment. This level of psychological safety is crucial for fostering an atmosphere where critical thinking and proactive problem-solving are encouraged and where beautiful questions are required. By supporting open communication and valuing diverse perspectives, healthcare organizations can detect potential issues earlier and respond more effectively.

Room for Data

While improving patient care and operational efficiencies relies on human judgment and actions, data still plays an important role. Analytics enable healthcare facilities to streamline processes such as operating room scheduling or managing turnover times more effectively. This, in turn, improves the patient experience and reduces stress on medical personnel. It also ensures that resources are leveraged wisely.

The use of analytics extends beyond scheduling into broader operational management. Hospitals and healthcare systems now have the capability to analyze large datasets for insights into patient care patterns, resource allocation, and staff efficiency. This approach allows for a more proactive management style, where potential issues can be identified and addressed before they become significant problems. Embracing analytics in operational processes is not just about adopting new technology but shifting toward a data-driven culture that prioritizes patient-centered care.

Real-time data collection and analysis is also imperative. It not only informs decisions in the moment but enables immediate adjustments — the kinds of adjustments that might save someone’s life. For example, real-time vital sign monitoring during surgery alerts healthcare professionals to potential complications. This type of value cannot be minimized or neglected. Rather, data and analytics should be seen as a partner or enhancement to what human teams can do.

Final Reflections

Data has never been prioritized more. It drives decisions across all areas of the healthcare spectrum, yet data isn’t everything. It’s all a matter of how one applies it.

Analytics tell part of the story, but human teams tell the rest. We must train every member to question, to prepare for the unexpected. Embracing analytics and fostering an environment of inquiry and high reliability are key to the future of healthcare. This approach promises better patient outcomes and more effective healthcare operations, pointing toward a future where data AND questions drive innovation. After all, the convergence of analytics and the art of asking “beautiful questions” represents a formidable force for transformative change.


About Jeffrey Oliver

Jeffrey Oliver, Lt. Col., (Ret.), is a clinical nurse specialist (CCNS), certified perioperative nurse (CNOR), and a clinical support specialist with LiveData. He has more than 30 years of nursing experience and has served in various nursing roles throughout his career. He was commissioned in the United States Air Force in 1995 and deployed three times during his 25-year career. In his last assignment, Jeff was appointed as faculty at the Uniformed Services University Graduate School of Nursing and served as the perioperative nursing consultant to the Air Force Surgeon General. He retired from the Air Force in March 2021 and served as the director of surgical services at a community hospital in South Carolina.