Series on High Reliability–The Journey Begins With A Single Step

Karl Weick and Kathleen Sutcliffe, both distinguished professors now at the University of Michigan, have spent years researching high reliability organizations (HROs)–organizations that despite operating under continual high-stress, high-risk conditions have very few failures. These organizations are also resilient by definition and as such, “practice a form of organizing that reduces the brutality of audits and speeds up the process of recovering.”

Aircraft carriers, air traffic control, commercial airlines and nuclear power plants provide examples of HROs, and now many healthcare organizations are looking to adopt and adapt the five principles of HROs outlined by Weick and Sutcliffe to prevent medical error from occurring within their institutions. Those five principles include:

  1. Preoccupation with Failure
    No matter how well these organizations are doing, they never rest on their success. They are constantly on the look out for any threat to successful execution, no matter how irrelevant it may seem.
  2. Reluctance to Simplify
    HROs embrace a critical eye and healthy skepticism of the ‘easy answers’. The more variables they can picture, understand, and plan for, the better.
  3. Sensitivity to Operations
    Front-line operations provide the situational information that drives the ability to adjust and adapt as necessary. HROs may be guided by strategy, but remain nimble and ready to react as the situation calls for change.
  4. Commitment to Resilience
    By preparing to prevent failure on a continual basis, HROs are ideally able to keep failures manageable or prevent them altogether. When errors do occur, HROs have ensconced within their culture, the ability to solve the problem and move forward without delay.
  5. Deference to Expertise
    HROs recognize that those with the most experience are not necessarily their experts. Experts on the front lines are called upon to make decisions on a regular basis in HROs.

Underlying all five principles is the core concept of mindfulness. Mindfulness, defined by Weick and Sutcliffe, is the ability of an organization to: 1) Notice the unexpected in the making, and halt its development; 2) Contain the unexpected if they can’t halt it; and 3) Restore as quickly as possible to normal function if they cannot contain it. A mindful approach to daily operations is a must have for any organization striving for high reliability.

Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement (IHI), along with Charles Kenney, an award-winning healthcare author, recently published, Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs, a book that highlights healthcare organizations that have become highly reliable, and how they have adapted Weick and Sutcliffe’s principles of an HRO to the healthcare environment.

Common to these innovative healthcare organizations are the following seven characteristics that have resulted in highly reliable safe outcomes for their patients. It will be these seven characteristics, built upon a mindful approach to daily interactions with one another, with patients and with the community, that will provide the framework for all entities to come together as one high reliability organization. These characteristics include:

  1. Transparency
  2. Patient Engagement
  3. Reporting
  4. Interprofessional Teamwork and Collaboration
  5. Measurement (HIT, data, outcomes)
  6. Respect/Support
  7. Strong Leadership

As Chassin and Loeb noted in their excellent article referenced in my previous post, the time for high-reliabilty thinking in healthcare is now. I couldn’t agree more.

Some additional excellent resources on HRO’s:

AHRQ: Becoming A High Reliability Organization—Operational Advice for Hospital Leaders

Joint Commission High Reliability Resource Center

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One Comment on “Series on High Reliability–The Journey Begins With A Single Step”

  1. […] Series on High Reliability–The Journey Begins With A Single Step « Educate the Young. […]


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