Tag: high reliability organizations

Business/Finances Leadership & Practice Management

#125 – Transformational Leadership with Adrian Moran, MD, MBA

Post author By Jon Lowrance
Post date 18/11/2025

Adrian Moran, MD, MBA currently serves as the Chief Medical and Transformation Officer of MaineHealth, a not-for-profit, integrated health system with over 2000 providers and 23,000 care team members serving patients across Maine and New Hampshire.

Dr Moran joined me to talk about his views on transformational leadership and his professional journey from a pediatric cardiologist at Boston Children’s Hospital to executive organizational leadership roles.

I’m excited to share his story with you because we don’t talk enough about how to transition from being specialized clinicians to working in healthcare leadership.

I asked Dr Moran to join me for this interview given his unique vantage point and journey to executive leadership. MaineHealth’s flagship level 1 trauma center, Maine Medical Center, is where I serve as the Director supporting the Department of Anesthesiology and Perioperative Medicine. Over the last decade, I’ve watched Dr Moran move from his clinical role as a pediatric cardiologist to MaineHealth board member to Associate Chief Medical Officer. I then saw him leave MaineHealth to take on a system level CMO role for a large health system in Wisconsin and then back to MaineHealth as the Chief Medical and Transformation Officer.

Over the years, I’ve seen his leadership style in action and recently heard him describe how the principles of high reliability organizing and servant leadership inform his work, which are ideas we’ve talked about here on the podcast over the last year or so.

In this conversation, we talk about:

the challenges facing healthcare organizations today and what leaders can do to be effective in supporting their teams
what transformational leadership looks like
the value of gaining practical experience and credibility as a healthcare leader
when and why additional education, like an MBA, might make sense for leaders
what motivates Dr Moran and what he sees as his core purpose

In full transparency, this interview was imbedded in a qualitative research course I’m taking as part of the PhD in Leadership & Organizational Develop at the University of Southern Maine. My goal was to explore the narrative arc of Dr Moran’s professional story and hear more about his leadership philosophy and work with MaineHealth.

I think yall are really going to enjoy this episode. Dr Moran is a remarkable leader, a pretty good story teller and incredibly generous for taking time out of his busy schedule to meet with me and share a bit of his story.

With that… let’s get to the show!

MaineHealth Announces Adrian Moran, MD, MBA as Chief Medical and Transformation Officer

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Tags healthcare leadership, high reliability organizations, leadership, transformational leadership

Business/Finances Leadership & Practice Management Leadership in Emergencies Preparing for Grad School/Residency

#118 – Resilience Engineering, Safety Differently & Synesis

Post author By Jon Lowrance
Post date 20/04/2025

This is Part 2 of a 3 part series on organizational development – how we work and live together as teams in healthcare so we can do our best work, master our craft, take amazing care of patients and actually enjoy the work we do. (no big deal)

In the first part (Episode 117), we talked about systems thinking and patterns of high reliability organizations (HROs). Systems thinking helps us zoom out to consider the complexity of situations and the various levers that influence outcomes. High reliability organizations adopt specific systems thinking practices to achieve consistent success in safety-critical, complex environments.

Resilience engineering builds on systems thinking and HRO theory by teaching us how to develop adaptive capacity, build for success (not just avoiding error) and bounce back when things don’t go well. Safety differently is about seeing safety as not the absence of mistakes and errors but the capacity for the right thing to happen. It also recasts the worker not as the weak link in a complex system (the point of failure), but as the source of resilience and capacity. Front-line healthcare workers – you and me – are often the ones who find the workarounds and get the job done despite suboptimal conditions.

No one shows up to their job with the intention to make mistakes, get hurt or put patients at risk. Mistakes are always unintentional. Willful acts of harm are something totally different. Blaming and shaming workers (forms of punishment & embarrassment) are counterproductive and stem from leaders who do not understand what’s actually going on or the best ways to run their organizations and build thriving teams.

Synesis, which sounds like a scary word, stems from the same Greek word that system and synergy come from and is actually kind of a cool idea. It’s the way we balance the often competing interests of productivity, safety, reliability and quality. We need to figure out how to do all of these things concurrently in healthcare. I’ll share some stories and examples of how to do that as an anesthesia provider in this episode.

So that’s where we’re headed with this podcast!

In Part 3, we’ll come back and talk about psychological safety and just culture, which thread all three episodes in this little mini-series together.

As a reminder, I’m teaching with Encore Symposiums next month in Hilton Head, South Carolina and back at the Cliff House in Maine this October. If you’re looking for a continuing education conference where we’ll talk more about all of this – or if you’re a resident or graduate student looking to check off one of your state/national meetings, come check us out! I’d love to see you there!

As always, you can come work with us at MaineHealth – Maine Medical Center. We have a phenomenal team of CRNAs, physician anesthesiologists, surgeons, OR nurses & CSTs, anesthesia techs and admin specialists. If you want to be part of a growing team of providers doing world class work at a level 1 trauma center in a spectacular city, check us out!

References

Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com

Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202

Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303.

Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge.

Larouzee, J., & Le Coze, J.-C. (2020). Good and bad reasons: The Swiss cheese model and its critics. Safety science, 126, 104660.

Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. Broadway Business.

Sutcliffe, K. M. (2011). High reliability organizations (HROs). Best practice & Research clinical anaesthesiology, 25(2), 133-144.

Wears, R., & Sutcliffe, K. (2019). Still not safe: patient safety and the middle-managing of American medicine. Oxford University Press.

Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world. John Wiley & Sons.

World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care (9240032703).

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Tags high reliability organizations, leadership, resilience engineering, safety & quality, safety differently, synesis, systems thinking

Leadership & Practice Management Preparing for Grad School/Residency

#117 – An Intro to Systems Thinking and High Reliability Organizations

Post author By Jon Lowrance
Post date 12/04/2025

Yo! This episode introduces the concepts of systems thinking and high reliability organizations. It’s the first part in a 3 part series. Part 2 is gonna dive into resilience engineering and safety differently. Part 3 is all about psychological safety and just culture.

These 3 shows unpack crucial intel for front-line providers, equipping them to understand their roles and how to develop their clinical impact. It’s also for organizational leaders and practice managers and will help you think about how to design better systems and support your team so they can thrive.

Systems thinking is the process of zooming out beyond simple cause-and-effect understanding (i.e. linear causality models) of how errors happen. It encourages people to consider the complexity of their environments and the power of leveraging changes in your processes and systems.

In this episode we cover:

Learning organizations and their 5 characteristics:
1. Personal mastery
2. Mental models
3. Shared vision
4. Team learning
5. Systems thinking
High reliability organizations and their characteristics
- Preoccupation with failure
- Reluctance to simplify
- Sensitivity to operations
- Commitment to resilience
- Deference to expertise
How these ideas link to resilience engineering and safety differently

“Every organization is perfectly designed to get the results it gets” (Batalden, 2015).

If you don’t like the results you’re seeing, you need to change the system. Whether this is your anesthesia team, hospital/OR or your personal life. If the outcomes are not what you desire, you need to adopt a systems thinking approach to change. This episode will walk you through how to do that.

The values you embrace shape your culture. Your culture builds your systems. Your systems generate your results.

Quick reminder: I’m teaching at Encore Symposium’s Hilton Head conference May 19-22 and then again with their fall conference at the Cliff House here in Maine that runs October 20-23, 2025. I love seeing y’all in person at these conferences. If you come because you heard about it here on the show or are just there and have checked the show out before, come holler at me! I’d love to chat with you about what you’re up to and what your practice is like.

Be sure to check out Part 2 and 3 of this series and I’ll see you there!

References