Reliability Organizations Research Articles

Reviewing High Reliability Team (HRT) Scholarship: A 21st Century Approach to Safety

High reliability team (HRT) theorizing emerged from high reliability organization (HRO) theory and now represents a distinct subset of HRO literature. Seeking to capture the development and range of HRT research, a comprehensive literature review was conducted. This systematic review of HRT scholarship, the first of its kind, provides a foundation from which small group and team scholars across disciplines may reflect on key lessons and chart future research. This review includes 71 articles across 21 disciplines and incorporates historical reflection on HRT theory foundations, existing empirical support, critiques and rivals, theory extensions, and ideas for future scholarship efforts.

Interprofessional teamwork in healthcare: Observations and the road ahead

ABSTRACT In this effort we draw from the literature on interprofessional teamwork in high reliability organizations from different fields of study, including healthcare, industrial/organizational psychology, and management. We combine this literature with our collective experience to offer five observations on future needs for the field of team science research and practice. These themes include: (1) exploration of nonclinical teams, (2) evaluation of multi-team systems in healthcare, (3) the study of dyad leadership of teams, (4) the proliferation of virtual healthcare teams, and (5) the continuing integration of organizational and team science into the study of interprofessional teams. By presenting these observations, we argue why each is critical to the overall understanding of interprofessional teamwork in healthcare and provide areas for future scholarly advancement that will inform healthcare practice.

Influencing a Culture of Quality and Safety Through Huddles.

Literature shows that interdisciplinary huddles help promote clear communication and proactive reporting of potential errors. High reliability organization (HRO) and just culture models were implemented, yet fragmented team communication about patient safety remained. Huddles were implemented to identify and address patient safety issues. A pre/postintervention design was used. Near-miss and actual event safety metrics, patient satisfaction, and employee satisfaction/work group perceptions were measured at 3 time points over 1 year. Daily interdisciplinary huddles were implemented to improve communication, reduce errors, and improve patient and employee satisfaction. Near-miss reporting increased across time points. Patient satisfaction with how the staff worked together to provide care significantly increased over time. Employee satisfaction and perception of work group communication, collaboration, and psychological safety scores improved, however, were not statistically significant. Implementing huddles demonstrated improved outcomes in patient safety, patient satisfaction, and employee satisfaction/work group perceptions.

366 Using a Serious Incident and Methods from High Reliability Organisations to Make Communications Safer Between A&E and Surgery

Abstract Aim Healthcare is a high-risk environment and for patients’ safety, requires high reliability. Poor communication is one of the leading causes of healthcare error worldwide and was one of the reasons that led to an adverse event in A&E. High Reliability Organisations (HROs) have set in place effective standards of safety where the probability of serious errors is very low. What translatable features can make the job of a Junior Surgical Doctor receiving patients from A&E safer? Method The root cause analysis of the serious incidence was discussed in a Surgical Morbidly and Mortality meeting. Focus groups and observational studies were carried out over a period of 6 months. The results formed the basis of a Task Analysis. A literature review of the evidence of safe communication method was performed and its translatability to healthcare. Results A “work as done” against “work as imagined” task analysis of the handover process showed multiple areas of potential “work system” error with references to the SEIPS 101 model. Combining the literature review and task analysis, standardisation (using SBAR), a handover checklist, read-back, dual-modality communication and a handover zone may prove to increase redundancy and slack in the system – making it safer. Conclusions There are HRO evidenced methods in making communication safer in healthcare. The aviation industries “sterile cockpit” and “crew management resource” methods are proven and effective. Their use of the above techniques can be implemented in healthcare communication. A designated “Handover Zone” could address potential errors. A QI project is required hereafter.

More Than a Catching Name? Entrepreneurial Ecosystem, Risk Anticipation and SMEs’ Resilience

This study investigates whether the commitment to risk anticipation influences small and medium enterprises’ (SMEs) resilience. Moreover, the research adds the entrepreneurial ecosystem (EE) mobilization to the analysis. Specifically, we study how the EE mobilization of SMEs coping with adversities relates with both risk anticipation and resilience. In doing so, we are aimed at contributing to resilience and EE literature, which overlooked the study of the relationship between the EE and resilience at the firm level. The exploitation of the EE resources may be useful for SMEs that cope with crises, as they rarely anticipate risks implementing the best (and costly) practice. Testing the impact of the EE mobilization on firms’ resilience may help us in clarifying – at least partially – the cause-effect network of the EE. This leads us to engage in the debate whether the EE is just a catching name or a valuable and usable construct. Drawing on the resilient response model, we develop a framework that includes risk anticipation and EE mobilization. To test our hypotheses, we estimate OLS regression and probit models using a dataset of 761 questionnaires. These were collected from London, Milan and Frankfurt SMEs’ entrepreneurs that experienced a crisis in the year before the research. We find that the commitment to risk anticipation enhances the EE mobilization level, that, in turn, increases SMEs’ probability of showing a resilient response. Surprisingly, no direct effect is found between commitment to risk anticipation and resilience. Results are commented drawing on High Reliability Organization theory: in particular, we argue that the mobilization of the EE increases the effectiveness and the efficiency of the activation and detection phases that characterize the critical period following the disruption. We posit that a crucial role is played by the increased variety of perspectives obtained via the EE mobilization, that supports a deeper understanding of the threat and a richer generation of solutions. Beside the scholarly debate about the value of the EE – to which we contribute demonstrating an empirical application of the construct –, from the results we derive managerial and policy implications concerning SMEs’ entrepreneurs’ strategies and EE planners’ initiatives.

Social Capital, Crop Specialization and Rural Industry Development—Taking the Grape Industry in Ningling County of China as an Example

Village-level social capital is an important factor to promote rural revitalization, but it is often ignored by existing researches. Based on the field investigation on 357 grape industry villages in Ningling County of Henan Province, decomposed village social capital into three dimensions (social network, social norm and social trust), this paper aims to discuss how village social capital influences rural industry development by promoting crop specialization. Results showed that the social network affects the transmission of grape planting information and technology. The richer the social network, the faster the diffusion of grape planting and the faster the realization of crop specialization. However, different types of social network play different roles. Social norms affect whether villages participate in grape production decisions. Proper risk awareness and efficient and reliable social organization services can help village farmers participate in grape planting and improve the level of crop specialization. Social trust affects the scale and duration of grape planting in a village; that is, the higher the level of social trusts, the higher the degree of crop specialization. In short, social capital can effectively promote the rapid cultivation of superior crops, enhance the specialization level of agricultural production and drive the coordinated development of upstream and downstream industries, thereby promoting the development of rural industries. This study emphasizes that, in the process of rural revitalization, developing countries should consider the social environments of different regions, fully mobilize the power of local social capital and develop reasonable and feasible technology popularization, adoption and implementation programs.

Improving Power Grid Resilience Under Extreme Weather Conditions With Proper Regulation and Management of DERs—Experiences Learned From the 2021 Texas Power Crisis

Due to climate change in the past few decades, extreme weather conditions have become more frequent and caused power outages with enormous damage to the well-being and the economy. Affected by extremely cold weather, the 2021 Texas power crisis deployed the most significant firm load shedding in US history, costing the economy $10 billion to $20 billion via direct and indirect loss. The North American Electric Reliability Organization (NERC), Federal Energy Commission (FERC), and other literature studies conducted post-event analysis from the perspective of conventional power systems’ planning and operation, and little discussion was made on the distributed energy resources (DERs). Based on the actual data on the 2021 Texas power crisis, this study analyzed the role of DERs in this event and showed the importance of effective regulation and management in improving power grid resilience under such extreme weather conditions.

The impact of work demands and operational tempo on safety Culture, motivation and perceived performance in safety critical systems

High reliability organizations (HROs) achieve high levels of safety performance through safety cultures grounded in trust and through reinforced norms and expectations that strengthen and motivate safety-related behaviors. Safety motivation and culture can be eroded by operational constraints, inadequate training, and job demands, but also mitigated by job resources such as adequate rest and preparation. Recent work has suggested that HROs can further enhance their reliability by marrying advanced analytical methods and diverse data sources and experiences. To that end, this work presents an exploratory partial least squares (PLS) model based on the Job Demands-Resources model that is used to consider the links between composite work demand factors and safety culture, safety motivation, and perceived safety performance in one HRO, the U.S. Navy. The model, based on 30 survey items (n = 3,803), suggests that attention to job resources that can bolster high levels of safety performance is important and consistent with safety practices in HROs. Job demands such as stress were found to be important safety motivators, as was sufficient rest. The results show the additive nature of job demands and resources, suggesting that they can support or diminish safety motivation and intent, consistent with previous studies.

Organizational Resilience: 30 years of intellectual structure and future perspectives

Objective. The knowledge structure was analyzed, during the period 1991-2021, on the factors that influenced organizational resilience to distinguish possible synergies, interactions, and new research lines.
 Design/Methodology/Approach. Using a performance analysis and scientific mapping approach, a bibliometric methodology was used to discover and represent conceptual subdomains and thematic development. This methodology consisted of four phases: (1) detection of research topics, (2) visualization of research topics and the thematic network, (3) discovery of thematic areas, and (4) performance analysis.
 Results/Discussion. Of the 869 publications on organizational resilience indexed in Scopus, the ones that had the most significant impact on the development of the topic were: Resilience; the concept, a literature review and future directions (2011), Developing a capacity for organizational resilience through strategic human resource management (2011), Developing a tool to measure and compare organizations' resilience (2013), Organizational resilience: Development of a conceptual framework for organizational responses (2011), and Facilitated process for improving organizational resilience (2008). The most important authors were Bhamra, R.; Burnard, K.; Seville, E.; Vargo, J. and Beck, T.E. The driving issues that over time have been closely related to the resilience of organizations were: risk management, standardization and regulation, psychological resilience, ICT resilience, protection and security, health personnel, and reliable organization.
 Conclusions. In recent years, when the subject has been more developed, it became clear that it is essential to observe risk management, health personnel, reliable organization, and decision-making to manage organizational resilience. Regarding possible future lines of research, the following was found: resilience of security networks, cybersecurity, cyber resilience, disaster management, organizational innovation, sustainable development, and sustainability management.

Technology Development Decision-Making Points and Differences in Identifying Commercial Opportunities for Mechatronics, Laser, and Nanoelectronic Technologies

There is a popular idea that technology-development success depends on some creative magic, but leaders contradict the assertion that innovation is a process that can be perfected. Turning technology into reality requires an excellent understanding of the development process from idea to market. The technology commercialization process is broken down into phases in which vital decision-making points exist. In the scientific literature, which examines and analyzes the process of technology development and its problems, there is a variety of views and opinions related to the concepts used to define this process and its content. These motives led to the formulation of the first objective of this article: to analyze technology-development models studied by different researchers and used by different reliable organizations. The second objective is to determine the content of the technology-development process and processes that are alternative or related to the content of the technology-development process, in this way elucidate the differences and interfaces between these models and the vital decision-making points. There are many vital decision-making points in the early stage of technology development. However, only one point—identification of commercial opportunities, determines whether technology will reach other vital decision points. Based on the results of this identification, large-scale investments are made. The decision made at this stage determines whether or not a project will have a successful return on investment. However, the specifics of the different technology industries are apparent, and these differences may affect the identification of commercial opportunities. The article also sought to reveal the specifics of commercialization for different technology industries. The research uses the integrated fuzzy Delphic-Eckenrode Likert-type scale-based rating technique for grey numbers to gather expert opinions and determine the weights of factors. The research results show the differences in identifying commercial opportunities for mechatronics, laser, and nanoelectronic technologies.

The divides that health organisations experience on their journey towards high reliability: Moving from theory to practice

Organisations, specifically in the healthcare industry, often find themselves in a state of ‘Reliability Divide’. This is a concept that the authors have developed to explain why most organisations never realise the culture change needed to become highly reliable. In an organisation there is a variable time frame to get to daily work. Because of the time involved, some of the front-line staff who participated in theory, academics and now operations have become mid- or lower senior level leaders. Along the journey they become the vector that infiltrates the organisation to reach Fabric. Multidirectional high reliability organisation (HRO) adoption starts to occur here, which further drives an organisation towards zero harm (nirvana).

The Perceived Role of Healthcare Providers and Systems in the Development of Secondary Health Conditions among Adults with Spinal Cord Injury

Individuals with spinal cord injury (SCI), with high healthcare utilization rates and costs, require special attention and tailored care protocols to meet their healthcare needs. This qualitative study collected narrative information from adults with SCI and their family members and/or caregivers to examine the perceived role of healthcare providers and systems in the development and treatment of secondary health conditions (SHCs). After personal information was collected, individuals participated in focus groups which were recorded and transcribed; transcripts were then reviewed, cleaned, and uploaded to NVivo10 software to facilitate the analysis. An initial stage of coding was conducted which identified potential categories and themes; afterwards, the perceived role of healthcare providers in the development and management of secondary health conditions (SHC) was prioritized and transcripts were re-coded. Two overlapping themes emerged: (1) Iatrogenic and nosocomial factors; and (2) Relationships with healthcare providers. Iatrogenic and nosocomial factors had three subthemes: (1) Misdiagnosis; (2) Perceived mistreatment or mistakes made during treatment; and (3) Unintended consequences of medical treatment; while three subthemes were identified for Relationships with healthcare providers: (1) Respect; (2) Knowledge and experience; and (3) Patient Expertise. To improve safety, reduce healthcare costs, and facilitate more favorable perceived outcomes for individuals with SCI, healthcare providers, organizations and systems need to implement principles of high reliability organizations to improve outcomes through the treatment and prevention of SHC.

Implementation of High Reliability Organizing (HRO): The Inherent Vice of Stress, Fear, and Threat

Implementation of High Reliability Organizing (HRO): The Inherent Vice of Stress, Fear, and Threat

Abstract 59: Increasing Participation In Improvement Work Through Heart Center Performance Rounds

Excellence in congenital cardiac care requires team resilience, complex decision-making, analysis of errors to adjust practice, and continuous targeted improvement. Medicine has learned from other high reliability organizations, but effective team communication and awareness of improvement opportunities remain challenging. We describe how our Heart Center Performance Rounds (HCPR) meeting addresses these gaps, and provides attention to quality improvement (QI) work, which in turn leads to increased participation and improved clinical outcomes. Our HCPR is a weekly review of one week’s worth of surgical and catheterization cases. Each patient’s course is reviewed against both internal and external benchmarks, such as length of stay (LOS) and markers of clinical progression. Eligibility for multidisciplinary improvement projects is reviewed for each patient. A committee tracks trends in discussion, assessing areas for improvement work and team learning. This committee then organizes methods for follow up and arranges presentation back to the Heart Center (HC) audience. Over the course of 12 months, we tracked LOS data and participation for two multidisciplinary QI projects to assess project participation and outcomes. Projects featured in HCPR included reduction of chest tube duration and awareness of median clinical targets. Patients undergoing specific operations were eligible, but could be excluded at the request of the clinical team. We noted a decrease in exclusion over 12 months, as teams became more aware of eligibility criteria and early results. As participation in these projects improved, both variability and overall length of stay decreased for 2 of 4 studied operations. Updates on outcomes were periodically presented to HC audience. Survey responses and interviews demonstrated increased awareness of projects and their potential for improved care metrics. Our HCPR has promoted knowledge of benchmarks and increased participation in quality improvement projects, leading to improved clinical outcomes. Transparency in data and communication of ongoing work is essential for success. Challenges include dedicated time and resources for spreading and sustaining improvement.

COVID-19 PANDEMİSİNDE GÜNAH KEÇİSİ MEKANİZMASININ KURBANLARI OLARAK GÖÇMENLER

In the COVID-19 pandemic, the strategy of constructing the disease as a threat caused by foreigners, and attempts to put the blame on the "other" went hand in hand with the outbreak. The accusatory index fingers were mostly aimed at immigrants. The xenophobic rhetoric that immigrants are potential carriers of the virus and pose a deadly health threat has become a central theme for populist politicians advocating curbing immigration. Under the pretext of containing the spread of the virus, some governments have instrumentalized the pandemic to justify strict immigration policies towards immigrants. This article attempts to provide a theoretical explanation of the tendency to scapegoat immigrants in crises. In addition, the news reports from reliable media organizations and the publications prepared by international organizations are examined and the practices of blaming immigrants for COVID-19 are evaluated. The study reveals that some politicians scapegoated immigrants by instrumentalizing COVID-19 to legitimize anti-immigration and these politicians, who were determined to have populist nationalist tendencies, used metaphors such as war, enemy, invasion in their discourses in order to construct the outbreak as an external threat. The study also displays that the tendency to blame immigrants is based on historical and cultural prejudices and that the infodemic is one of the most important factors that ignite the scapegoat mechanism

Adaptation of a Lean Tool Across Surgical Units to Improve Patient Experience.

High reliability organizations (HROs) sustain consistently excellent outcomes over time. Health care systems need to eliminate major quality failures to become reliable. Practice variations, unstructured leader rounds, and unfavorable patient experience outcomes with Responsiveness of Hospital Staff prompted leaders to adopt Kamishibai cards (K-cards). Evidence-based practices (EBPs) such as timeliness of answering call lights, purposeful rounding, communication, and engaging patients were used to develop Responsiveness K-cards. Responsiveness K-cards established standard work for staff responsiveness and audited process compliance. Findings determined what areas needed improvement, and leaders engaged frontline staff in practice changes. Percentile rank for Responsiveness of Hospital Staff had a sustained increase. Four of 6 hospital units using Responsiveness K-cards achieved 80% rank or better in every patient experience domain for the entire fiscal year. K-cards use HRO principles to standardize practice and improve outcomes. They encourage continuous improvement, which supports the sustainability of EBPs.

Creating a Process for the Implementation of Tiered Huddles in a Veterans Affairs Medical Center.

ABSTRACTIntroductionIn 2019, the Veteran’s Health Administration began its journey in pursuit of becoming an enterprise-wide High Reliability Organization (HRO). Improving the delivery of safe, high quality patient care is a central focus of HROs. Requisite to meeting this goal is the timely identification and resolution of problems. This is best achieved by empowering and engaging both clinical and non-clinical staff across the healthcare organization through the promotion of robust collaboration and communication between various disciplines. Improved care coordination and increased accountability are two important subsequent outcomes. One method for accomplishing this is through the implementation of tiered huddles.Materials and MethodsAn extensive review of the current literature from 2013 until June 2021 was conducted for evidence highlighting the experiences of other healthcare organizations during implementation of huddles. Following the review, a tiered huddle proposal was developed and presented to the executive leadership team of a healthcare system for approval. Pilot testing of the tiered huddle implementation plan began in October 2021 over a 12-week period with three services. On average, the pilot services had between three to four tiers from frontline staff to the executive level of leadership.ResultsOver the 12-week period, out of the possible 120 tiered huddles that could have been conducted, 68% (n = 81) were completed. Of the tiered huddles conducted, 99% (n = 80) started and ended on time. During the pilot test, seven issues were identified by frontline staff: coordination of pre-procedural coronavirus testing, equipment/computer issues, rooms out of service, staffing levels, and lack of responsiveness from other departments. Issues related to staffing, unresponsiveness from other departments, and equipment concerns required elevation to a higher-level tier with no issues remaining open. Delays in patient care, or prolongation of shift hours for staff because of tiered huddles, was low at 2.5% (n = 2). For the duration of the pilot test, a total of 75 minutes accounted for shifts being extended among five staff members.ConclusionsThe success of this initiative demonstrates the importance of thoughtfully creating a robust process when planning for the implementation of tiered huddles. The findings from this initiative will be of immense value with the implementation of tiered huddles across our healthcare system. We believe that this approach can be used by other healthcare institutions along their journey to improving patient safety and quality.

Tying in Situational Awareness, Clinical Reasoning and Clinical Judgment through Cross-Training Using Case-Based Discussions in Emergency Medicine

Situational Awareness (SA) is knowing about what is going on around oneself, whether as an individual or as a team. It is the mental impression of where you are, what surrounds you and what lies ahead. SA has been noted to be one of the most important non-technical skills in medicine. It is a foundational concept in many high reliability organizations and industries for its importance in operational decision-making. Clinical Reasoning essentially summarises the process of making timely and accurate diagnosis. It goes through the steps of history taking, physical examination, performing diagnostic investigations, interpreting the results that are returned and planning management for patient care. It is a fundamental in the practice of medicine and even in today’s context of technology and Artificial Intelligence (AI) applications, these steps are incorporated into the algorithmic formulae. Clinical Judgment, on the other hand involves the process of “noticing, interpreting, responding and reflection” Just from the three definitions above, it can be seen that there may be overlaps between the three terms. They are also very often used almost interchangeably. Practitioners of academic medicine, educators and faculty, need to understand the similarities and differences between the three terms. They are often called upon to assess their learners in these domains. Thus, clarity on what each term exactly means is essential. In this paper, the author shares her experience as an educator and core faculty in Emergency Medicine Residency on the utilization of Case-Based Discussions (CBD) in the nurturing and inculcation as well as assessment of all these three domains. The ability to plan and use CBD in such a manner is time efficient and effective for emergency physicians, as it can be consciously prepared with the coverage of SA, CR and CJ skills all incorporated into the shared narrative or scenario management.

Quality and Safety in Health Care, Part XCV: Sensemaking.

Many times in high reliability organizations, there is uncertainty about the meaning of various happenings or circumstances. Unfortunately, in an emergency, there is often no time to fully investigate events or what is going on in the environment before action must be taken to avoid unfortunate results or disaster. In groups, sensemaking refers to the process of interrelating with others so that a shared understanding may be reached, taking advantage of the differing observations, expertise, and opinions of the people involved, and then taking appropriate action.

Promoting Psychological Safety in Healthcare Organizations.

Healthcare organizations across the United States have begun the journey to high reliability as one method for improving patient safety. Being a High Reliability Organization (HRO) requires constant vigilance for ensuring the delivery of system-wide excellence in patient quality and safety. Establishing a foundation for high reliability requires the engagement of personnel across the organization from frontline staff to executive leadership. Staff must feel comfortable voicing concerns in order to be fully engaged. However, we believe this is easier said than done. The purpose of this article is to describe the importance of psychological safety along the journey to becoming an HRO. Additionally, strategies for promoting a psychologically safe work environment are provided.