Characteristics Of High Reliability Organisations Research Articles

Just Culture: How Do We Address Risky and Unprofessional Behaviors that Lead to Errors?

Unprofessional behavior in the procedural arena is associated with worse patient outcomes. This is thought to be due to breakdowns in communication structures and team dynamics. Behavioral issues are often uncovered during the investigation of serious event reports. Understanding differences in behavior deviations enables leadership to best address each type with an appropriate response. This allows institutions to address reckless behavior and unprofessionalism, while concomitantly creating a culture that fosters trust to promote self-reporting and sharing of information. These are characteristics of high-reliability organizations that produce sustained excellence in patient outcomes.

Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects.

Quality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects. An online survey was completed by 51% (n = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods. Faculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (n = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%). Gaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.

A Study Investigating How the Characteristics of High Reliability Organisations Can Be Measured in the Construction Industry in Australia.

Construction activities involve a lot of risk as workers are exposed to a wide range of job hazards, such as working at height, moving vehicles, toxic substances, and confined spaces. The hazards related to a construction project are mostly unpredictable because construction projects move quickly due to project deadlines, and changing work environments. As a result of this, the industry accounts for one of the highest numbers of work-related claims, and the fourth highest incidence rate of serious claims in Australia. This research investigates how key safety management factors can measure the characteristics of high reliability organisations (HROs) in the construction industry in New South Wales Australia. To address the problem, a model is presented that can predict characteristics of HRO in construction (CHC). Using structural equation modeling (SEM), and confirmatory factor analysis (CFA), the model and measurement instruments are tested and validated from data collected from construction workers. The results identified the factors that effectively measure CHC, and the findings can also be used as a safety management strategy and will contribute to the body of knowledge in research.

British government communication during the 2020 COVID-19 pandemic: learning from high reliability organizations

This article examines British government communication during the COVID-19 pandemic, assessing how it aligns to the communicational characteristics of high reliability organizations (HROs). The central proposition of the study is that HROs’ organizational culture enables and cultivates effective, ethical communication that, in turn, enhances the trust and engagement of stakeholders and citizens. A thematic content analysis of the UK prime minister’s public communication about the new coronavirus outbreak, examining televised statements, news briefings and prime minister’s questions from January to June 2020, shows that the British prime minister’s initial approach to communication about the virus was complacent about the country’s preparedness and capacity to control the disease’s spread. No errors were admitted in any of the government’s subsequent handling of the pandemic nor were mistakes acknowledged in the actions of those in or advising government. These approaches to communication are at odds with those adopted by HROs. The study suggests that lessons can be learnt from HRO practices for communication in high risk environments. They are also applicable to organizations that have experienced historical difficulties both in admitting errors and in fostering a transparent, responsive communicational culture.

Security Organizing

In the knowledge economy, organizational information is one of a firm's most valuable assets. However, despite significant advances in information security (InfoSec) research, problems in the field persist. This paper contends that advances in reliability and safety can help inform the future of InfoSec research. Specifically, the paper presents a framework for security organizing that is based on previous research about the organizational mindfulness characteristics of high reliability organizations (HROs). This paper considers the similarities among reliability, safety, and InfoSec, provides an initial validation of a potential construct for measuring security organizing in the workplace, and discusses opportunities for future research.

Developing resilient supply chains: lessons from high-reliability organisations

PurposeThe purpose of this study is to identify the prescribed formative elements of supply chain resilience (SCR) in literature, to compare them with the unique characteristics of high reliability organisations (HROs) and derive lessons useful for improving SCR.Design/methodology/approachTwo systematic literature reviews are carried out as follows: one on SCR and the other on HRO, which identified 107 studies and 18 papers, respectively. The results from the review are presented, analysed and synthesised.FindingsFindings suggest that despite significant similarities in some of the proposed formative elements for SCR and the characteristics of HROs, the strong managerial commitment exhibited in HROs is absent in SCR literature. More importantly, the most cited characteristic of HROs, which is their flexible decision making structure is pointed out as a prima lesson towards developing resilience in supply chains.Practical implicationsA decision making framework to facilitate flexible decision making for supply chains during crisis is presented. Further, practical lessons are pointed out from principles common to both streams of literature such as redundancy, human resource management, collaboration, agility, flexibility, culture and risk avoidance that can be implemented in supply chains.Originality/valueThis paper is the first study to systematically review HROs, adapt a HRO decision making framework and also apply the Cynefin framework to SCR. This, therefore, provides the basis to launch further research into the use of these theories and the role of decision-making in SCR creation.

Comparing the Evolution of Risk Culture in Radiation Oncology, Aviation, and Nuclear Power.

All organizations seek to minimize the risks that their operations pose to public safety. This task is especially significant if they deal with complex or hazardous technologies. Five decades of research in quantitative risk analysis have generated a set of risk management frameworks and practices that extend across a range of such domains. Here, we investigate the risk culture in three commercial enterprises that require exceedingly high standards of execution: radiation oncology, aviation, and nuclear power. One of the characteristics of high reliability organizations is their willingness to learn from other such organizations. We investigate the extent to which this is true by compiling a database of the major publications on risk within each of the three fields. We conduct a bibliographic coupling analysis on the combined database to identify connections among publications. This analysis reveals the strength of engagement across disciplinary boundaries and the extent of cross-adoption of best practices. Our results show that radiation oncology is more insulated than the other two fields in its adoption and propagation of state-of-the-art risk management tools and frameworks that have transformed aviation and nuclear power into high reliability enterprises with actuarially low risk. Aviation and nuclear power have established risk cultures that cross-pollinate. In both nature and extent, we found a distinct difference in radiation oncology's engagement with the risk community, and it lags behind the other two fields in implementing best practices that might mitigate or eliminate risks to patient safety.

Front-Line Ownership: Imagine

When used in a military context, the term front line refers to the interface between enemies in action on the battlefield. In a non-military context, the front line is the site where the core activity defining a particular industry takes place, and those working there are key to successful operations. In healthcare, the need to improve patient safety has become a global imperative, and an armamentarium of strategies, tools and technological approaches have been adapted or developed for this context. Often neglected, however, have been strategies to engage the healthcare workers, those at the front line, in the cause.In order for healthcare to function error free, we must assume the characteristics of high-reliability organizations. In particular, the ability to bounce back, to be resilient in the face of a catastrophe, is of paramount importance. Those working at the front line may have the answers. We need to create an opportunity for them to be heard.`

Managing incidents in the water utility sector – towards high reliability?

Do water utilities exhibit characteristics of high organisational reliability? Here, the reported characteristics of high reliability organisations (HROs) were explored within a regional water utility, and specifically within their incident response team. We found the utility well positioned to manage incidents and that many HRO principles were identifiable as management practice under these trying conditions. The observance of HRO principles contributed to the resilience of the organisation and toward the maintenance of a safe and reliable drinking water supply. An investigation of technical reliability in the system showed that the utility invested heavily in automated monitoring and control systems and took a differentiated, risk-based approach towards resource allocation to that of HROs, which maintain existing technology with zero tolerance of defective, substandard or malfunctioning equipment.

Abstract P34: Use of a Behavioral Measure of Safety Culture Among Healthcare Workers in Cardiovascular Care

Medical error is a complex and systemic problem requiring systemic solutions. Developing a “safety culture” and adopting characteristics of high-reliability organizations (HROs, e.g. aviation, nuclear power) can form a basis for reducing error and patient harm in healthcare. Vanderbilt Heart and Vascular Institute (VHVI) has set a long-term goal of providing the highest level of patient safety in cardiovascular care. An early step in this process was measuring our current organizational status in order to achieve a safety culture. We created a survey tool that would gauge the current status of our organization in terms of HRO practices that underlie a safety culture. The tool (Table) utilized items adapted from concepts that comprise the process of mindful organizing seen in HROs: preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience, and deference to expertise. Also, items were included that measured factors proposed to enable mindful organizing and high reliability including leader-member exchange, safety climate, and psychological safety. A baseline assessment of safety culture using the tool has been administered via electronic web-based survey to VHVI physicians, nurses, and staff. We have performed detailed analyses of responses by respondent role (e.g. physician, nurse, staff, and administrator) and area (e.g. clinic, stepdown unit, intensive care unit, diagnostic lab). These results have been shared with leaders and front-line staff in each clinical area to develop specific strategies to create a safety culture and more reliable performance. We intend to implement changes in our organization to promote patient safety and then re-administer the tool to gauge progress. We conclude that this tool can help assess and guide organizational change to create and sustain a safety culture that yields highly reliable performance Survey Tool Summary Survey Tool Concept Areas (example items) Score Range Total # Survey Questions Mindful Organizing- (We spend time identifying activities we do not want to go wrong, We discuss alternatives as to how to go about our normal work activities, We talk about mistakes and ways to learn from them) 1-7 9 Leader-Member Exchange (In my workgroup we know where we stand with our clinical manager) 1-5 9 Safety Climate (My clinical manager approaches employees during work to discuss patient safety issues) 1-5 9 Psychological Safety (In my workgroup it is safe to take an interpersonal risk) 1-5 4

Managing Unknowns in Projects

A challenge in most projects is to deal with unexpected events or conditions that may influence projects accomplishment. An outline of a structure that can be used when addressing these events or conditions is presented in this paper. High Reliability Organizations (HRO) has ways of acting and managing that make them able to handle the unexpected, hallmarks and characteristics of HRO are presented in this paper. This paper do furthermore suggests ways of acting and managing, so that project organizations may be able to address and manage unexpected events or conditions in projects.

Safety Management Assessment System (SMAS): a process for identifying and evaluating human and organization factors in marine system operations with field test results

Eighty percent or more of major marine accidents are caused or influenced by humans and organizations. Research has identified characteristics of high reliability organizations (HRO), organizations which have had few accidents while involved in operations where failure would result in severe consequences. These characteristics have important effects on the safety of marine systems. Assessing systems for these HRO characteristics is the first step in reducing accidents caused by human and organization factors (HOF). The Safety Management Assessment System (SMAS) was developed specifically to assess marine systems (offshore platforms, marine terminals, ships) for HOF. SMAS is a screening method that selects and trains operators of the system to conduct a self-assessment. The assessment process takes five days and has the assessors making comparisons and evaluating HOF by selecting ranges and providing comments to capture the uncertainty. Included in the process is a visit to the system. A computer program was developed to assist in the assessment process. A field test of SMAS was conducted at a marine terminal in California. Two teams, with members from the terminal and the regulatory agency, along with a facilitator, were selected and trained. These two independent teams conducted separate evaluations on the same marine terminal. A comparison of their assessments showed that the use of ranges and comments were very helpful. An analysis of field test data shows that SMAS can produce results more consistent than randomness. SMAS shows promise as an efficient and practical method to assess humans and organizations.