High Reliability Organization Principles Research Articles

A Model of Communicative and Hierarchical Foundations of High Reliability Organizing in Wildland Firefighting Teams

Organizational hierarchy is an inescapable aspect of many exemplary high reliability organizations (HROs). As organizations begin to adopt HRO theorizing to improve practice, it is increasingly important to explain how HRO principles—which assume the hallmarks of a flat hierarchy—can be understood and enacted in rigidly stratified organizations. We propose a preliminary theoretical model suggesting how various supervisor–subordinate and work group communication patterns and practices enable members to navigate hierarchy to achieve high reliability. We test the model using structural equation modeling on a sample of N = 574 U.S. wildland firefighters from three federal agencies. Results suggest how organizational members might overcome common hierarchy-based constraints to HRO through considering how leaders throughout a chain of command communicate to cultivate the necessary cross-level awareness of an operation, and ways in which supervisors, members, and groups might cultivate interactional cultures with respectful affect.

Learning to become a high reliability organization in the food retail business

This case discusses Selectos, a retail chain based in El Salvador, which was put under severe strain when Walmart entered its domestic market, threatening the leading position it had acquired through many decades of investment. The case illustrates that Selectos succeeded in competing Vis a Vis Walmart because it implemented the principles of high reliability organizations. First, before Walmart entered the market, the Salvadoran company invested time and financial resources to audit its routines, finding several areas of improvement. Second, its core strategy was to focus on continuous improvements in its operations. Third, it engaged its workforce, and especially the shop floor managers, in the process of executing its strategy at the whole corporate level. Fourth, through consultation with the managers of its functional areas, it enacted systems to manage unexpected events, ranging from hurricanes to violent attacks on its facilities (preparation for unexpected events). The case is designed to illustrate how a domestic firm from an emerging market competes with a leading multinational corporation, emphasizing the importance of organizational learning, especially the development of routines and mechanisms that allow for flexibility and adaptability to changes in conditions.

Got (the Right) Milk? How a Blended Quality Improvement Approach Catalyzed Change

The expression, storage, preparation, fortification, and feeding of breast milk are common ongoing activities in many neonatal intensive care units (NICUs) today. Errors in breast milk administration are a serious issue that should be prevented to preserve the health and well-being of NICU babies and their families. This paper describes how a program to improve processes surrounding infant feeding was developed, implemented, and evaluated. The project team used a blended quality improvement approach that included the Model for Improvement, Lean and Six Sigma methodologies, and principles of High Reliability Organizations to identify and drive short-term, medium-term, and long-term improvement strategies. Through its blended quality improvement approach, the team strengthened the entire dispensation system for both human milk and formula and outlined a clear vision and plan for further improvements as well. The NICU reduced feeding errors by 83%. Be systematic in the quality improvement approach, and apply proven methods to improving processes surrounding infant feeding. Involve expert project managers with nonclinical perspective to guide work in a systematic way and provide unbiased feedback. Create multidisciplinary, cross-departmental teams that include a vast array of stakeholders in NICU feeding processes to ensure comprehensive examination of current state, identification of potential risks, and "outside the box" potential solutions. As in the realm of pharmacy, the processes involved in preparing feedings for critically ill infants should be carried out via predictable, reliable means including robust automated verification that integrates seamlessly into existing processes. The use of systems employed in pharmacy for medication preparation should be considered in the human milk and formula preparation setting.

Ohio Children's Hospitals' Solutions for Patient Safety: A Framework for Pediatric Patient Safety Improvement.

Building upon their previous collective success and a clinical imperative for rapid improvement, the eight tertiary pediatric referral centers in Ohio sought to dramatically decrease the most serious types of harm that occur to hospitalized children by collectively employing high reliability methods focused on safety culture. With the support of the hospitals' executives, the Ohio collaborative obtained legal protection and built will by clearly identifying types and frequency of harm events that occur in each participating hospital and across the state. The improvement efforts were divided among task forces designed to incorporate the principles of high reliability organizations into the work of all employees, focusing primarily on the consistent application of error prevention behaviors. Between January 2010 and October 2012, the serious safety event rate among the participating hospitals decreased by 55%, equating to 70 fewer children per year who experienced this most severe type of event in the participating hospitals. Between January 2011 and October 2012, all events of serious harm were decreased by 40%, meaning 18 fewer children per month suffered serious harm. Rapid and significant improvement in pediatric patient safety is possible through collaboration of children's hospitals dedicated to the application of high reliability principles and the noncompetitive sharing of outcomes and best practices.

Improving Situation Awareness to Reduce Unrecognized Clinical Deterioration and Serious Safety Events

Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or ≥ 3 fluid boluses in first hour after arrival or before transfer. The setting for our observational time series study was a quaternary care children's hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (SSEs) and floor-to-ICU transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns. Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a "robust" and explicit plan for at-risk patients was developed and spread. The rate of UNSAFE transfers per 10,000 non-ICU inpatient days was significantly reduced from 4.4 to 2.4 over the study period. The days between inpatient SSEs also increased significantly. A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs.

Controle da qualidade no laboratório clínico: alinhando melhoria de processos, confiabilidade e segurança do paciente

INTRODUÇÃO: Inúmeros questionamentos têm sido levantados com relação ao nível da qualidade dos serviços de saúde, principalmente a partir do início desta década. Uma abordagem que tem sido utilizada como base teórica para essa questão é a de organização da alta confiabilidade (HRO). Neste trabalho, propomos nova abordagem para o controle da qualidade analítica (CQA), com base nos princípios da teoria das HROs e com foco na ampliação do nível de segurança para os clientes no laboratório clínico. OBJETIVOS: Propor uma abordagem complementar para o sistema de CQA, alinhado à teoria HRO, com foco na ampliação do nível de segurança do paciente. MATERIAIS E MÉTODOS: Visando aprimorar a abordagem tradicional para o CQA, viabilizando a análise de estabilidade do sistema analítico com visão de longo prazo, propomos um modelo embasado em avaliação de erro aleatório e sistemático, utilizando cartas de controle avançadas. Para validar o modelo, realizamos simulações, utilizando dados reais obtidos da rotina (glicose, Vitros FS 5.1, OCD). RESULTADOS: O ensaio em estudo foi avaliado em termos de desempenho de longo prazo, apresentando desempenho adequado (4,1 sigma) para seu uso diagnóstico. DISCUSSÃO: O modelo proposto oferece alternativa multiferramenta, com base no conhecimento já amplamente estabelecido de controle estatístico de processos, visando à utilização no controle de estabilidade de longo prazo de métodos laboratoriais. CONCLUSÃO: A abordagem proposta como complementar ao sistema de controle de qualidade (CQ) tradicionalmente utilizado, envolvendo a aplicação sequencial e associada de diferentes ferramentas estatísticas, mostrou-se válida e útil para uma avaliação efetiva do desempenho do método e da estabilidade desse desempenho ao longo do tempo.

Is “If It Will Make Any Difference Clinically” Acceptable?

HomeRadiologyVol. 255, No. 3 PreviousNext CommunicationsLetters to the EditorIs “If It Will Make Any Difference Clinically” Acceptable?Herbert R. KaufmanHerbert R. KaufmanAuthor AffiliationsHuron Valley Sinai Hospital, Commerce Township, Mich 32287 Spruce Ln, Beverly Hills, MI 48025 e-mail: [email protected]Herbert R. KaufmanPublished Online:Jun 1 2010https://doi.org/10.1148/radiol.100364MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Reference1 Ginsberg LE. “If clinically indicated:” is it? [editorial]. Radiology 2010;254(2):324–325. Link, Google ScholarArticle HistoryPublished online: June 2010Published in print: June 2010 FiguresReferencesRelatedDetailsRecommended Articles Diagnosis Please Certificates of Recognition Awarded to Three Individuals and to International and North American Radiology Resident GroupsRadiology2017Volume: 285Issue: 2pp. 336-339Editor’s Note: January 2018Radiology2017Volume: 286Issue: 1pp. 7-8Reflection on the Evaluation of Radiologists' Performance during Off-Hours ShiftsRadiology2021Volume: 298Issue: 3pp. E165Repeat Contrast Medium Administration for Patients with Mild Immediate Hypersensitivity Reaction to Iodinated Contrast MediaRadiology2018Volume: 290Issue: 1pp. 270-271Better Together: How Machine Learning Can Help Clinicians Determine If My Father Will Develop Parkinson Disease DementiaRadiology2021Volume: 300Issue: 2pp. 400-401See More RSNA Education Exhibits Building a Decision Aid Tool for Femoroacetabular Impingement (FAI) Patients with Incorporation of ImagingDigital Posters2019Applying the Principles of High Reliability Organizations and Just Culture to Foster Patient Centered Care in RadiologyDigital Posters2020Establishing a Registry for Medical 3D Printing Digital Posters2019 RSNA Case Collection Ischiofemoral Impingement SyndromeRSNA Case Collection2022Re-entry High Altitude Pulmonary Edema RSNA Case Collection2021Occipital condyle fractureRSNA Case Collection2020 Vol. 255, No. 3 Metrics Altmetric Score PDF download

The Past as the Future of Emergency Preparedness and Management

Emergency preparedness, planning, and response suffer from shortcomings that impede the potential for effectiveness. In this article, we provide an overview of Emergency Preparedness and Management that is based upon our research, including insights into the shortcomings of current practices, a discussion of relevant theories (e.g., High Reliability Organizations, muddling through) and recommendations to promote more effective planning, management, and response. Our recommendations include system support for the principles of High Reliability Organizations and muddling through, rethinking risk analysis to have a longer-term view and reflect more than just monetary loss, creating ways to better inform and involve the public, and encouraging collaboration and collective intelligence through such means as a dynamic Delphi voting system.

Quality Initiatives in Radiology

HomeRadioGraphicsVol. 28, No. 1 PreviousNext Quality InitiativesQuality Initiatives in RadiologyPresident’s Address from the Opening Session of RSNA 2006: Strengthening Professionalism1Robert R. HatteryRobert R. HatteryAuthor Affiliations1From the American Board of Radiology, 5441 E Williams Blvd, Suite 200, Tucson, AZ 85711. Presented at the 92nd Scientific and Annual Meeting of the Radiological Society of North America, Chicago, November 26, 2006. Received and accepted August 21, 2007. The author has no financial relationships to disclose.Address correspondence to the author (e-mail: [email protected]).Robert R. HatteryPublished Online:Jan 1 2008https://doi.org/10.1148/rg.281075200MoreSectionsFull text ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In "Quality Initiatives in Radiology." RadioGraphics, 28(1), pp. 7–11References1 Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000. Google Scholar2 TerkelS. Working: people talk about what they do all day and how they feel about what they do. New York, NY: New Press, 1974. Google Scholar3 The Hippocratic Oath. Modern version by Louis Lasagna, 1964. Google Scholar4 Council on Ethical and Judicial Affairs, American Medical Association. Code of medical ethics: current opinions with annotations, 2002–2003. Chicago, Ill: American Medical Association, 2002. Google Scholar5 The Medical Professionalism Project, the 2005 RSNA Professionalism Committee. Medical professionalism in the new millennium: a physicians’ charter. Radiology 2006; 238: 383–386. Link, Google ScholarArticle HistoryPublished in print: Jan 2008 FiguresReferencesRelatedDetailsCited ByMindful leadership for personal and organisational resilienceJ.Levey, M.Levey2019 | Clinical Radiology, Vol. 74, No. 10Practice Corner: Is Radiology Education Ready for a Flipped Classroom?Douglas E. Green, , and Michael F. McNeeley, 2 March 2013 | RadioGraphics, Vol. 33, No. 2Views of Radiology Program Directors on the Role of Mentorship in the Training of Radiology ResidentsAndreaDonovan2010 | American Journal of Roentgenology, Vol. 194, No. 3The Maintenance of Certification Exam: Who Cares?David J.DiSantis2010 | American Journal of Roentgenology, Vol. 195, No. 1The Impact of External and Internal Forces on Education, Certification, and Maintenance of CertificationThomas H.Berquist2010 | American Journal of Roentgenology, Vol. 195, No. 3Keeping Professionalism Alive in Radiology's New Age: A Choice; Our FutureGregory J.Butler2009 | Journal of the American College of Radiology, Vol. 6, No. 2Ensuring Patient Safety: A Summary of the 2008 Intersociety ConferenceN. ReedDunnick2009 | Journal of the American College of Radiology, Vol. 6, No. 4Editorial Quality Initiatives in Radiology: Historical Perspectives for an Emerging Field1Jonathan B. Kruskal, 1 January 2008 | RadioGraphics, Vol. 28, No. 1Maintenance of Certification: Everyone Needs to ParticipateThomas H.Berquist2008 | American Journal of Roentgenology, Vol. 191, No. 3Recommended Articles Lessons on LeadershipRadioGraphics2018Volume: 38Issue: 6pp. 1688-1693Contemporary Risk Management for RadiologistsRadioGraphics2018Volume: 38Issue: 6pp. 1717-1728Customer Service in Radiology: Satisfying Your Patients and ReferrersRadioGraphics2018Volume: 38Issue: 6pp. 1872-1887The Future of Radiology ConsultationRadiology2016Volume: 281Issue: 1pp. 6-9RSNA-MICCAI Panel Discussion: Machine Learning for Radiology from Challenges to Clinical ApplicationsRadiology: Artificial Intelligence2021Volume: 3Issue: 5See More RSNA Education Exhibits Pandemic Preparedness: Streamlining the Breast Imaging Patient Care and Teaching Experience During COVID-19Digital Posters2020Applying the Principles of High Reliability Organizations and Just Culture to Foster Patient Centered Care in RadiologyDigital Posters2020Leading a Multigenerational WorkforceDigital Posters2020 RSNA Case Collection Amoebic abscess RSNA Case Collection2020Stroke following CT guided chest biopsy RSNA Case Collection2020Low Lying Conus with LipomaRSNA Case Collection2022 Vol. 28, No. 1 Metrics Altmetric Score

Patient safety in obstetrics

Obstetrical care providers are highly trained, highly skilled professionals working with complex systems in an unpredictable environment. Perinatal units have many built-in mechanisms that work to prevent errors from occurring. Unintentional failures usually are the result of a chain of events, almost never from a single cause or a single provider. Within most unintentional failures, there is usually no single explanatory cause for the event. Rather, there is a complex interaction between a varied set of systems, including human behavior, performance and interdependency, technological aspects, socio-cultural factors, and a range of organizational and procedural weaknesses. To enable meaningful analysis of the underlying causes of an adverse event, errors and near-misses must be made visible. The challenge lies in the integration of labor and delivery clinical core business with high-reliability organization principles. The human factors knowledge should be considered a required part of the undergraduate and postgraduate medical education. Safety science and human factors engineering need to be applied to perinatal care, and each health care professional should be able to recognize the basic theories, rules, and principles. Business and industry provide many lessons for perinatal care when focusing on error prevention through standardization, information technology, and, last but not least, acknowledging the relationship between team-building and improved performance. This will allow all obstetrical caregivers to build and maintain confidence and competency in their daily clinical activities, which ultimately is believed to result in reduction of clinical error. This review on current patient safety issues as they are applicable to the field of perinatal care attempts to create a sense of urgency towards the creation of a safety-conscious culture in obstetrics. Such a culture fosters a collective approach of responsibility to learn and improve constantly. This process takes time to develop and requires dedicated and highly visible leadership support at every level.

The Common Barriers and Facilitators for a Healthcare Organization Becoming a High Reliability Organization

Background: Implementing high reliability organization principles can enhance quality and safety in healthcare. Evidence-based instructions on how to effectively change the organizational culture in healthcare setting are required. Objectives:  A systematic review investigating methods, facilitators, and barriers to assist healthcare organizations in becoming a high reliability organization. Method: Literature searches were performed in PubMed, MEDLINE, CINAHL-Complete, EMBASE, and Scopus for articles published between January 2012 and October 2017. The included articles were case reports, case studies, and protocol development studies on implementing high reliability organization principles. The articles were appraised using a modified Critical Appraisal Skills Programme tool. Thematic synthesis was conducted using manual coding.  Results: Of the 14 eligible articles nine were case studies, four were case reports, and one was a framework development report. The study populations varied from whole healthcare systems to a single department of a hospital. The most common methods were supportive leadership, staff education, and analysing the safety events and sharing the knowledge. Cost was one of the barriers. Remuneration came in reduction of safety events and costs avoided. Conclusion Implementing high reliability organization principles in healthcare settings is slow and challenging, but doing so improves quality, resilience, and safety, thus increasing productivity.

Managing Risk, Clinical Error, and Quality of Care

Clinical risk presents enormous challenges for the health profession and governments. Despite excellent national and regional programs focused on the management of obstetrical conditions and prevention of newborn injury, an environment of clinical error persists; according to Canadian Medical Protective Association data, each year 6% of Canadian obstetricians face a legal challenge, with most cases also involving nurses and hospitals. Principles and lessons learned from risk management developed in high reliability organizations (HROs), such as air traffic controllers and nuclear power plants, can be applied to risk management in perinatal/obstetrical units. In 2002, the Society of Obstetricians and Gynaecologists of Canada will launch an obstetrical risk management program called “Managing Obstetrical Risk Efficiently” (MORE), integrating labour and delivery clinical core content with HRO principles and reflective learning and practice modification tools designed to help all obstetrical caregivers build and maintain confidence and competency, improve patient safety and quality of care, and reduce clinical error and adverse events.