The Safety of Work

Ep.14 What are the characteristics of a High Reliability Healthcare Organisation?

Feb 16, 2020

Explore the fascinating world of High Reliability Organizations (HROs) in healthcare. Discover how these organizations achieve safety in high-risk environments by focusing on failure and fostering resilience. Learn about the challenges of researching HROs and the importance of transparent methodologies. Hear about the role of reflexivity and the significance of empowering frontline healthcare workers. Delve into case studies that reveal how teamwork and a blame-free culture can enhance patient outcomes in complex medical settings.

38:38

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Quick takeaways

High-reliability organizations prioritize empowering frontline workers and fostering teamwork over rigid hierarchies to improve patient safety and outcomes.

The transition from a high-reliability culture to a low-reliability model can rapidly undermine performance, highlighting the fragility of these principles during personnel changes.

Deep dives

Understanding High-Reliability Organizations (HRO)

High-reliability organization (HRO) theory seeks to explain why certain organizations operating in high-risk environments experience fewer accidents than expected. Originating in the 1990s, HRO characteristics emphasize a preoccupation with failure, sensitivity to operations, a commitment to resilience, and a reluctance to simplify complex situations. A key aspect is deferring to expertise rather than solely relying on formal management, which highlights the importance of frontline workers in ensuring safety and operational efficiency. Various industries, including aviation and nuclear power, have successfully implemented HRO principles to maintain safety and reliability over extended periods.

Intro

3min

Understanding High Reliability Organizations

12min

Understanding Reflexivity and High Reliability in Pediatric Healthcare

3min

Empowering High Reliability in Healthcare

15min

Understanding High Reliability Organizations: Lessons from Complexity

2min

Evolving Roles of Healthcare Workers

5min

To frame our discussion, we use the common High Reliability Organization Theory. A few people have authored papers on this topic and we will use their work during our chat.

Topics:

What defines an HRO’s modus operandi.
Why it was revolutionary to study successful organizations.
Being transparent about research methods.
The difficult job of figuring out who the “expert” is, in a given situation.
The things that can encourage safety on a team.

Quotes:

“A number of organizations and industries have been linked to HRO theory over the years for maintaining somewhat error free operations over an extended period of time.”

“The technical name we use when talking about the position of the researcher, compared to the research they’re doing, is ‘reflexivity’.”

“It’s what model lets us make use of the local expertise and the professional expertise...as we’ve shifted to the model that gave primacy to the physicians, we lost that teamwork…”

Resources:

Roberts, K. H., Madsen, P., Desai, V., & Van Stralen, D. (2005). A case of the birth and death of a high reliability healthcare organisation. BMJ Quality & Safety, 14(3), 216-220.

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