High Reliability Organizations Research Articles

Élaboration et mise en œuvre de mesures de productivité de l’anesthésie pédiatrique localement dans un hôpital canadien pour enfants : un rapport technique

Élaboration et mise en œuvre de mesures de productivité de l’anesthésie pédiatrique localement dans un hôpital canadien pour enfants : un rapport technique

WHOLE Communication: A High Reliability Organization Approach to Post-Acute-Long-Term-Care Education

WHOLE Communication: A High Reliability Organization Approach to Post-Acute-Long-Term-Care Education

Implementation of High Reliability Organization (HRO) in the Air Traffic Controller (ATC) Profession in Indonesia

The ATC profession in Indonesia is a profession that has a high risk and workload, this has also been proven by the establishment of the ATC organization as a High Reliability Organization (HRO). The implementation of HRO is very important to be carried out properly because it has an impact on the performance of ATC personnel which also directly affects flight safety. There are also HRO principles and attributes that have a high standard to run. Therefore, the purpose of this study is to determine the application of HRO to the ATC profession in Indonesia. The method used in this study is a mixed-method, with the category of descriptive analysis and the Miles and Huberman model. The results of the study based on the data analysis test using a Likert Scale, showed the results were Enough with a percentage of 59%. Meanwhile, based on the data analysis test using archives/literature studies, HRO's Goals were produced, in which there were 21 (twenty one) goals/targets.

Creating, executing and sustaining a high-reliability organization in health care

Purpose This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities. Design/methodology/approach The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI). Findings HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy. Practical implications This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries. Originality/value This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study.

Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.

How High Reliability Can Facilitate Clinical, Organizational, and Public Health Responses to Global Ecological Health Risks.

High reliability organizations operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. High reliability can be described as a condition of persistent mindfulness within an organization, coupled with a relentless, assiduous prioritization of adverse event prevention. This article describes ethically and clinically relevant features of high reliability that health care organizations can draw on to anticipate, identify, and respond to global ecological health threats.

Early-career employees sensemaking strategies in organizationally constrained workplaces: a longitudinal multiple-case study

PurposeThis study aimed to investigate the sensemaking strategies employed by early-career employees working within organizationally constrained environments.Design/methodology/approachGrounded in the sensemaking-as-accomplishment framework, a longitudinal multi-case study was conducted, involving three early-career employees. These participants were interviewed multiple times concerning tasks they themselves identified as anomalous and ambiguous.FindingsThe study's findings illuminate how early-career employees utilize sensemaking strategies to accomplish anomalous-ambiguous tasks. These strategies are interwoven with deliberate efforts to mitigate organizational constraints that exist in the organization or arise during the execution of complex tasks.Research limitations/implicationsNotable limitation pertains to the time gap between task completion and the interviews. Conducting real-time interviews concurrently with task execution or immediately afterward was not feasible due to constraints in participant availability. This research has implications for organizational learning initiatives, particularly those encompassing employee-driven self-learning components. Insights derived from studies like this can inform the development of effective self-learning schemes within organizations.Originality/valuePrevious sensemaking research focused on what takes place in high-reliability organizations. This study explored sensemaking strategies in workplaces that are organizationally constrained.

Technical Tips: The Role of the Charge Neurodiagnostic Technologist

ABSTRACT The purpose of this strategic staffing study was to retrospectively evaluate the impact of the charge neurodiagnostic technologist (NDT) within a 24/7 pediatric NAEC Level IV, ABRET LAB-LTM accredited epilepsy monitoring unit (EMU) during a 4-month pilot. The association between a high-reliability organization (HRO), Lean thinking, and organizational strategic goals were utilized as guiding principles. This paper reviews the operational need to further develop frontline neurodiagnostic leadership roles within Ann & Robert H. Lurie Children’s Hospital of Chicago along with the design and implementation, training, and competencies required.

A contribuição da Ergonomia para a segurança no trabalho

Abstract Introduction: while high-risk processes with high accident rates challenge safety, High Reliability Organization (HRO) achieve excellent indicators. In both cases, prevention seems to have reached a limit. In the former, because it seems powerless to generate prevention; in the latter, because it has been so successful that it seems impossible to reach greater levels. Objective: to highlight the contribution of Ergonomics to safety in these situations, pointing out unexplored possibilities such as design Ergonomics in man-machine integration (computerized systems). Method: comparative analysis of findings from ergonomic studies on production systems with high accident rates and HRO. Discussion: analysis of the motorcycle freight drivers’ activity revealed alternatives yet to be explored between unfavorable work relations and the perceived inevitability of accidents. The apparent limit of HRO can be overcome with recent advances in the analysis of situated action and cognition and by building debate spaces based on field experience. Collaborative design practices, which draw on worker experience to feed learning dynamics and technical reliability, remains a poorly explored possibility in Safety Engineering when it comes to computerized systems.

Age-Friendly Health Systems and Meeting the Principles of High Reliability Organizations in the VHA

Age-Friendly Health Systems and Meeting the Principles of High Reliability Organizations in the VHA

Learning to manage the unexpected: applying Weick and Sutcliffe’s HRO principles to oil tanker accidents

PurposeWeick and Sutcliffe identified five principles that enable high-reliability organizations (HROs) to address environmental complexity and manage unexpected events. The current study aims to adopt this sensemaking perspective to analyze accidents within a typical HRO sector, namely maritime transport.Design/methodology/approachThrough a retrospective case study analysis, this study focused on seven oil tanker accidents, using them as illustrative examples.FindingsFindings show how the five principles contributed to the accidents' occurrence, explaining how failures in sensemaking affected the crew's capability to both prevent errors and cope with their consequences, thus leading to disasters.Research limitations/implicationsOverall, the study offers an applicative contribution showing how this model may provide a reliable framework for analyzing the psychosocial factors affecting an accident. This approach deepens the understanding of how latent factors are enacted and how the prevention and error management phases interrelate within a comprehensive flow of the entire accident sequence. Furthermore, the study emphasizes consistent patterns that emerge across multiple accidents within the same sector, in order to learn valuable lessons to improve safety measures in the future.Originality/valueThis study constitutes an exemplary application in support of how Weick and Sutcliffe’s model is valuable for investigating HROs. It offers a second-order interpretative framework to understand accidents and underscores the interplay among these factors during the dynamic development of an accident.

Sustainability in High Reliability Organizations Employing Digitized Automation Inspection Processes

Digitization technologies offer several advantages over manual methods of accomplishing job-related tasks. Accurately measuring, documenting, and reporting surface damages, due to volume calculation variations are vital in increased efficiency, productivity, and thus mainly, human performance. Several sensation and perception issues were identified, mainly with concerns about accuracy of visual measurements that take place during quality control inspections. This research project portrays High Reliability Organizations utilizing digitized systems and automation concepts, with emphasis in Sensation, Perception, and Human Performance. Problem areas in measuring and assessing damaged Thermal Protection System (TPS) tile surfaces are identified and documented. Analysis of performance issues, causes, and effects, of human error factors are analyzed.

Briefings in surgical teams: a pilot study of experiences and attitudes

While healthcare should not be compared to other high reliability organisations (HROs), many lessons, attitudes, and transferable practices can be applied and adapted from them to improve patient safety and team morale. Despite briefings improving both patient safety and effective team working, some in healthcare have not valued or actively engaged with them, deeming them to be irrelevant. In this pilot study we explored the experiences of, and attitudes to, briefings using a 10-question Survey Monkey. This was promoted during a human factors session at the 2023 Association of Surgeons in Training Conference (ASiT) and at a large NHS trust. Questions were asked about the number of briefings per day, attitudes, engagement, and respondents’ attitudes to them. In total, 109 responses were received. A total of 85% reported at least one briefing on a normal operating day, 65% felt them to be interactive, 67% reported that briefings were led by the most senior surgical team member, and 58% lasted four minutes or more. Eighteen per cent of respondents felt they were of little benefit, and 56% did not routinely de-brief at the end of the day. This study has highlighted variable attitudes to team briefings, with some colleagues still seeing them as a ‘tick box’ exercise. While culture has changed following the introduction of the WHO checklist, the importance of active engagement and education to improve the delivery and value of effective briefings cannot be overestimated. It is also an opportunity to create a ‘safe space’ for team members and to confirm zero tolerance for any inappropriate behaviour, including sexual misconduct.

No Harm in Learning – A Balanced High Reliability Organisation (HRO) Approach in Healthcare

Abstract This multi-site study measures different aspects of patient safety culture within selected secondary and tertiary care NHS hospitals by applying High Reliability Organisations (HRO) principles. We propose a new balanced definition of HRO within health setting with a new maturity grid, and use an instrument to survey various staff across hospitals. An electronic online questionnaire surveyed all staff grades across three NHS hospital trusts. The sample consisted of 1,243 randomly selected staff. We used a high reliability organisation (HRO) framework consisting of five dimensions to estimate maturity levels linked to patient safety culture to create a measurable and replicable process for benchmarking and improvement. The proposed maturity grid provides a clear and concise road map to support senior managers in formulating a patient safety strategy based on a higher level in maturity with respect to HRO five principles. The proposed methodology can also predict the likely direction of improvement, or deterioration, if no action is taken with respect to each of the HRO principles. Although healthcare leaders consider the principles of high reliability organisations (HROs) as a guide for strategy to improve patient safety, there is evidence that these principles are underused in the measurement and subsequent analysis of their impact on patient safety culture. Our approach provides a structured methodology that aims to contribute to streamlining implementation and monitoring of HRO principles towards improving safety and resilience.

Building Cultures of High Reliability: Lessons from the High Reliability Organization Paradigm.

Safety models from disciplines outside of health care have begun to diffuse into the health care safety arena. This article explores high reliability organizing (HRO) theory, which privileges culture as means to adaptively learn and reliably perform. A brief history of the HRO paradigm and factors that contribute to cultures of high reliability is provided, followed by review of existing research to discern which HRO ideas have diffused into research on anesthesiology and perioperative care. High reliability research is growing and concepts seem useful; but there is a long way to go before the benefits of HRO are fully realized.

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.

Exploring the pathways to enhanced task performance: the roles of supportive leadership, team psychological safety, and mindful organizing

PurposeThe study investigated the predictive role of supportive leadership and psychological safety for mindful organizing and the subsequent impact of mindful organizing on individual task performance. Mindful organizing, a concept from high-reliability organizations (HROs), can improve performance in various industrial settings. The limited availability of novel predictors for mindful organizing necessitates exploring this concept in the context of adventure tourism.Design/methodology/approachThrough a cross-sectional research approach, 394 respondents were selected from the adventure tourism industry in Malaysia. The proposed causal research model was evaluated through structural equation modeling (SEM), aggregation and bootstrapping.FindingsPsychological safety and supportive leadership significantly impacted mindful organizing. Mindful organizing, in turn, was positively associated with individual task performance. The mediating role of mindful organizing between psychological safety and task performance was statistically significant. However, the mediating role of mindful organizing between supportive leadership and task performance was not statistically significant.Practical implicationsManagers in the adventure tourism industry should consider applying mindful organizing to increase employee productivity and develop collective sensemaking. Also, developing a culture of support among managers and coworkers, emphasizing the team's psychological safety, may boost the morale and productivity of the workforce.Originality/valueThis research has identified and empirically tested new antecedents, psychological safety and leadership for mindful organizing in the adventure tourism context and has addressed a significant research gap (Sutcliffe et al., 2016) by broadening the scope of mindful organizing research to encompass contexts beyond those exclusively considered HROs.

To err is human: A healthcare organization blueprint towards safety and reliability.

392 Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate <0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events.

Managing disruption(s) at work: A longitudinal study of communicative resilience and high-reliability organizing

ABSTRACT This paper used communication theory of resilience (CTR) and high-reliability organization (HRO) theory to investigate the influence of resilience processes on disruption management outcomes (DMOs) at both the individual and team levels and at two points in time. Perceptions of individual and team stress, efficacy, and performance were examined longitudinally in surveys with working adults (N = 192, 151). Results indicated (a) communicative resilience was significantly related to improvements in DMOs at time 1 (T1), (b) highly-reliable organizing was significantly related to improvements in DMOs for individuals and teams at both collection times, and that (c) high-reliability organizing practices were generally more predictive of positive DMOs than communicative resilience; however, the two forms of resilience are compatible and complementary.

Primary care teams’ reported actions to improve medication safety: a qualitative study with insights in high reliability organising

BackgroundOur aim was to understand actions by primary care teams to improve medication safety.MethodsThis was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative...