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From the C&A Classroom: Journeying to High Reliability for Patient Safety

Vintage blackboard or school slate

In November, Darlene Christiansen provided a presentation entitled, Journeying to High Reliability, as part of C&A’s monthly webinar series. Darlene presented the components of what constitutes an HRO, key factors that must be considered along the HRO journey and actions that can be taken on the road to zero harm.

High reliability is an organizing concept that stems from a range of high risk industries including aviation, nuclear power plants, firefighting and is also applicable to healthcare. Social psychologist Weick (1993), and other scholars, were instrumental in forming a definition of high reliability organizations (HROs) as” organizations which have fewer than normal accidents. This decrease in accidents occurs through change in culture.”. (http://high-reliability.org/faqs) The literature lists five common characteristics found in HROs in any of the high risk industries, grouped according to two categories by Weick that best contain the ideas – anticipation and containment. These include:

  • Anticipating and becoming aware of the unexpected
    • Preoccupation with failures rather than successes
    • Reluctance to simplify interpretations
    • Sensitivity to operations
  • Containing the unexpected when it occurs
    • Commitment to resilience
    • Deference to expertise

Weick also points out that mindfulness is a key characteristic of an HRO team member. He says, “Mindfulness is a mental orientation that continually evaluates the environment as opposed to mindlessness where a simple assessment leads to choosing a plan that is continued until the plan runs its course. Mindfulness track small failures, resists oversimplification, remains sensitive to the operations in practice, maintains the capability for resilience, and takes advantage of changes in who has expertise.” (http://high-reliability.org/Weick-Sutcliffe)

The ultimate goal of an HRO is 100% prevention and elimination of harm. This requires a new approach in healthcare – from a leadership shift to empower decision making at the front lines (deference to expertise), to every member of the team becoming mindful.

Dr. Christiansen, in her presentation, emphasized the need to talk about vision every day to keep members of the team focused on the ultimate goals. The vision cannot be accomplished without adequate resources allotted for the purpose. Effective leaders at all levels of the healthcare organization need to be identified and brought on board to realize the vision’s high priority initiatives. Deference to expertise is one of the five core principles and this means that identifying those at the front lines with expertise in their given areas need to be cultivated and provided opportunity for leadership to emerge.

Any high-risk industry like aviation or a nuclear power plant, and especially, healthcare, must be successful in preventing, containing and eliminating risks that pose a threat to passengers, workers, patients and staff. Whether it be a healthcare acquired infection or a fire in the operating room, there remain significant risks in the healthcare setting.

High reliability is a journey that begins with the adoption of a central vision that is realized through the five principles stated in this article and conducted in a mindful manner with every member of the team engaged for their expertise. Where are you on the journey?

Weick K, Sutcliffe K. 2007. Managing the unexpected: Resilient performance in an age of uncertainty. San Francisco, CA: Jossey Bass.

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