High Reliability Organization Theory Research Articles

Developing a relational playbook for cardiology teams to cultivate supportive learning environments, enhance clinician well-being, and veteran care.

Despite the Veterans Health Administration (VA) efforts to become a learning health system (LHS) and high-reliability organization (HRO), interventions to build supportive learning environments within teams are not reliably implemented, contributing to high levels of burnout, turnover, and variation in care. Supportive learning environments build capabilities for teaching and learning, empower teams to safely trial and adapt new things, and adopt highly reliable work practices (eg, debriefs). Innovative approaches to create supportive learning environments are needed to advance LHS and HRO theory and research into practice. To guide the identification of evidence-based interventions that cultivate supportive learning environments, the authors used a longitudinal, mixed-methods design and LHS and HRO frameworks. We partnered with the 81 VA cardiac catheterization laboratories and conducted surveys, interviews, and literature reviews that informed a Relational Playbook for Cardiology Teams. The Relational Playbook resources and 50 evidence-based interventions are organized into five LHS and HRO-guided chapters: Create a positive culture, teamwork, leading teams, joy in work, communication, and high reliability. The interventions are designed for managers to integrate into existing meetings or trainings to cultivate supportive learning environments. LHS and HRO frameworks describe how organizations can continually learn and deliver nearly error-free services. The Playbook resources and interventions translate LHS and HRO frameworks for real-world implementation by healthcare managers. This work will cultivate supportive learning environments, employee well-being, and Veteran safety while providing insights into LHS and HRO theory, research, and practice.

High Reliability Organization in Medical Technology in Health Service

Introduction: Medical technology in health services is often regarded as a solution to the quality of health services. This is because medical technology is considered a solution in reducing errors in medical decision-making. Technology in the world of health aims to increase the effectiveness and efficiency in medical services. The purpose of doing this research is to find out how the benefits of HRO theory are in realizing work safety in hospitals.
 Methods: This research used a qualitative design for collecting the data from information obtained through the skype instrument. The number of respondents in this study was 15 respondents where 1 respondent was a pilot respondent who was interviewed early to develop questions that approached the HRO theory developed.
 Results: The purpose of this research is to see how reliable emergency room nurses in hospitals in the safety of patient care through questions created based on five basic principles of high-reliability organization. Safety programs in health services are developed through high-reliability organization theory and are used to enhance safety culture and guide organizations in Indonesia to learn from mistakes that have occurred but these cannot be measured as numbers.
 Conclusion: High reliability organizations can assist in a comprehensive approach to assisting health service organizations in providing effective and reliable services and interventions. By using the principles in high reliability organization, an organization can take valid steps to support the sustainability of a system free from errors.

The human cost of chronic mindfulness in U.S. law enforcement: toward a more nuanced understanding of HRO theory

ABSTRACT High-reliability organization (HRO) research has nearly always presented HRO theory positively, causing a skewed perspective that favors implementation of these principles without adequate understanding of the costs to HRO members of chronic mindfulness. This paper presents some of the costs to workers of implementing HRO theory. Without proper management, mindfulness can be exhausted when workers experience protective distortion. A phronetic iterative approach identified five consequences of protective distortion: compulsive hypervigilance, complexity avoidance, mental fatigue, jadedness, and a pathological assumption of responsibility. Contrary to unequivocal calls from HRO researchers for all organizations to implement these principles, organizational leaders should exercise mindfulness regarding how they implement mindfulness-promoting practices. We also identified four coping strategies employed by participants: avoiding, reframing, seeking professional therapy, and cathartic expressing. Those officers who were best able to avoid the costs identified above, were those who had means of testing their sensemaking through open communication with trusted others.

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.

Toward a theory of high reliability for natural gas distribution utilities

High-reliability organizations facilitate the reliable accomplishment of high-risk goals while avoiding catastrophe. Our paper evaluates natural gas utilities in the United States against the features of high-reliability organization (HRO) theory. We ask: 1) How is high-reliability organizational theory applicable to natural gas infrastructure? And 2) How might natural gas hazards be reconsidered using HRO models of industrial organization? We conclude that natural gas organizations are not high reliability but might be in a period of transition toward becoming HROs. Our conclusions are cautionary, noting that the expanded use of this energy source poses substantial environmental and societal risks under present organizational circumstances.

Retail inventory shrinkage, sensing weak security breach signals, and organizational structure

AbstractRetail inventory shrinkage, resulting primarily from employee theft and shoplifting, costs retailers nearly $70 billion annually. With brick‐and‐mortar retailers today confronting increased competition and low future growth expectations, reducing inventory shrinkage is becoming even more critical to becoming profitable. This paper analyzes a unique dataset that combines both primary survey and objective archival data from a Fortune 500 retailer to test a theoretical model associating retail inventory shrinkage, the capacity of a retail store to sense weak security breach signals, centralization of decision making, and formalization of security breach management. The analysis builds on insights from high reliability organization theory and the literature on organizational structure. Results reveal that as a retail store increases its capacity to sense weak security breach signals, it observes decreases in store‐level inventory shrinkage, with this negative association amplified (dampened) when the retail store has formalized procedures and protocols for managing security breaches (has centralized decision making within the retail store). Moreover, while the establishment of formalized procedures and protocols for managing security breaches bolsters the capacity of a retail store to sense weak security breach signals, centralizing decision making has the opposite effect. Our findings contribute to the retail operations literature by introducing a new store‐level organizational capability to guard against theft‐based retail inventory shrinkage and by offering novel insights into how and why organizational structure at the level of a retail store deters or facilitates the capacity to sense weak security breach signals. From a practical perspective, these findings advise retailers to develop the capability to become aware of and to mitigate security breaches. Further, to support this capacity, retailers are urged to decentralize decision making to retail store personnel and to invest in formalizing procedures and protocols for managing security breaches in order to deter retail thefts that shrink retail store inventory.

Facilitating mindful safety practices among first-line workers in the Chinese petroleum industry through safety management practices and safety motivation

ABSTRACT The petroleum industry is a high-risk industry and operates under the social technical system. Therefore, the safety behavior of employees needs to be paid high attention. Thus, six dimensions of safety management practices are identified as independent variables to predict a special component of common safety behavior-mindful safety practices in the Chinese petroleum industry. High-reliability organization theory is adopted as the underpinning theory. A total 255 first-line workers from a Chinese petroleum company participated in this survey. The results reveal that safety training and safety communication and feedback are positively related to safety motivation. Moreover, workers’ involvement and safety promotion policy have direct and positive impacts on mindful safety practices. Further, safety motivation is found to play a mediating role in the prediction of mindful safety practices in the Chinese petroleum industry. These findings give new insights for petroleum companies into how to promote mindful safety practices in the workplace.

Are Public Bureaucracies Supposed to Be High Reliability Organizations?

This article addresses the question of to what extent conventional theories of high reliability organizations and normal accidents theory are applicable to public bureaucracy. Empirical evidence suggests precisely this. Relevant cases are, for instance, collapsing buildings and bridges due to insufficient supervision of engineering by the relevant authorities, infants dying at the hands of their own parents due to misperceptions and neglect on the part of child protection agencies, uninterrupted serial killings due to a lack of coordination among police services, or improper planning and risk assessment in the preparation of mass events such as soccer games or street parades. The basic argument is that conceptualizing distinct and differentiated causal mechanisms is useful for developing more fine-grained variants of both normal accident theory and high reliability organization theory that take into account standard pathologies of public bureaucracies and inevitable trade-offs connected to their political embeddedness in democratic and rule-of-law-based systems to which belong the tensions between responsiveness and responsibility and between goal attainment and system maintenance. This, the article argues, makes it possible to identify distinct points of intervention at which permissive conditions with the potential to trigger risk-generating human action can be neutralized while the threshold that separates risk-generating human action from actual disaster can be raised to a level that makes disastrous outcomes less probable.

Applying MAC-F Method for Causes Analysis of the Proven Medication Error in a Moroccan Hospital

Medication error (ME) is a serious problem of public health. Difficulties related to the management of this error are numerous. Each stage of this process suffers from several flaws: identification, root causes analysis and improvement. This paper focuses on root cause analysis of medication error. We developed an original semi-quantitative method named “MAC-F (Méthode d’Analyse des Causes basée sur la Fiabilité globale, in French). It’s specific to the hospital context and constitutes a decision-making tool for professional of care. It based on a rigorous theoretical and conceptual framework (human reliability theory and high reliability organization theory). We used our method MAC F to analyze serious proven medication errors. They have been collected over the past six months (from January to June 2020) in Moroccan hospital. The reliability matrix shows that the overall reliability index is very low (Ω= 0,07). Moroccan hospital is therefore unreliable. The failure of the organizational system (Ω CF= 0,03) and the absence of preventive strategies (ΩIF= 0) don’t help practitioners to recover the medication errors (ΩSF= 0,23). Root cause analysis is the most critical step in managing medication errors. Our aim is to provide healthcare professionals with a decision support tool “MAC-F” that we believe will help them to prevent Medication Errors and to achieve overall reliability (reliable organization and practitioner). Our method was tested in a Belgian hospital before and Moroccan hospital recently.

High Reliability Organization (HRO) systematic literature review: Discovery of culture as a foundational hallmark

AbstractThe term “high reliability organization” (HRO) evolved from research countering the claim by Perrow after the 1979 Three Mile Island nuclear plant incident that “accidents happen,” implying that failures were inevitable. Soon after the publication of Perrow's book researchers began questioning his assertion, by observing that some organizations exhibited significantly higher rates of reliability. In 2001, Weick and Sutcliffe converged on five principles, or hallmarks, which became the de facto characteristics most often cited since. Since 2001, HRO theory spread to non‐high‐risk industries and the amount of published literature has more than doubled, including several literature reviews. This led to the questions, “how has HRO theory evolved since the seminal research, how far has it spread from high risk industries, and what is the focus of HRO research?” Seeking to capture the breadth of spread of HRO as well as the dominant areas of research and practice, a comprehensive literature review was performed to capture the most current state of theory and practice. The results show HRO theory within the published literature has not significantly evolved past the original characteristics and hallmarks. Though the theoretical implications have not changed much the practical implications have grown and spread throughout the critical infrastructure sectors. In conclusion, the research team believes that a culture of reliability is the sixth hallmark that works synergistically with certain foundational organizational characteristics and allows mindfulness, which is the distinctive hallmark of HROs, to thrive and grow. This is the fundamental difference between “reliable” and “highly reliable” operations and differentiates HROs from well‐run organizations that are not HROs.

Minimizing Mistakes in Psychological Science

Developing and implementing best practices in organizing a lab is challenging, especially in the face of new cultural norms, such as the open-science movement. Part of this challenge in today’s landscape is using new technologies, including cloud storage and computer automation. In this article, we discuss a few practices designed to increase the reliability of scientific labs, focusing on ways to minimize common, ordinary mistakes. We borrow principles from the theory of high-reliability organizations, which has been used to characterize operational practices in high-risk environments, such as aviation and health care. Guided by these principles, we focus on five strategies: (a) implementing a lab culture focused on learning from mistakes, (b) using computer automation in data and metadata collection whenever possible, (c) standardizing organizational strategies, (d) using coded rather than menu-driven analyses, and (e) developing expanded documents that record how analyses were performed.

Linking Workplace Safety to Operational Disruptions: A Moderated Mediation Analysis in Commercial Vessels

Little is known about the mechanism of how workplace safety may affect operational disruptions manifested as unplanned maintenance in commercial vessels. Building upon the high reliability organization theory as a broad framework, we propose that workplace safety climate influences how employees identify and report errors at work. Specifically, no‐blame error reporting mediates the relationship between safety climate and unplanned maintenance in vessels. Additionally, we posit that the mediation effect varies among vessels in that it is stronger (weaker) in newer (older) vessels that are easier (harder) to maintain operationally. We test the moderated mediation framework at the vessel level of analysis using an archival survey data with multiple responses from 1,169 crewmembers in 86 marine vessels. Our results lend support to the mediation effect in that safety climate facilitates no‐blame error reporting, which subsequently reduces the frequency of unplanned maintenance. In particular, the effect of safety climate on unplanned maintenance is fully mediated by no‐blame error reporting. As vessel owners attempt to maximize their return on investments in aging ships, the mediation effect shows a high level of safety climate in a vessel is indirectly associated with a significantly lower level of unplanned maintenance rate relative to a similar age vessel but with an average level of safety climate. However, the mediation effect weakens as a vessel ages. This study contributes to important insights into how safety climate can reduce operational disruptions (unplanned maintenance events) through error reporting behaviors, contingent upon the age of ocean carriers in logistics companies.

Improving service operations: linking safety culture to hospital performance

PurposeThe purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.Design/methodology/approachPatient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.FindingsThe findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.Practical implicationsHospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.Originality/valueThis is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

Improving Patient Safety through High Reliability Organizations

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data including process standardization, checks and redundancy, authority migration, communication, and teamwork. The themes uncovered the need for extensive education and training, communication, and teamwork to improve patient safety. The results of the study may be useful to improve safety and enhance leadership to promote a culture of safe patient care.

Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda.

The US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response's current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness.

Learning from Accident and Error: Avoiding the Hazards of Workload, Stress, and Routine Interruptions in the Emergency Department

This article presents a model of how a build-up of interruptions can shift the dynamics of the emergency department (ED) from an adaptive, self-regulating system into a fragile, crisis-prone one. Drawing on case studies of organizational disasters and insights from the theory of high-reliability organizations, the authors use computer simulations to show how the accumulation of small interruptions could have disproportionately large effects in the ED. In the face of a mounting workload created by interruptions, EDs, like other organizational systems, have tipping points, thresholds beyond which a vicious cycle can lead rather quickly to the collapse of normal operating routines and in the extreme to a crisis of organizational paralysis. The authors discuss some possible implications for emergency medicine, emphasizing the potential threat from routine, non-novel demands on EDs and raising the concern that EDs are operating closer to the precipitous edge of crisis as ED crowding exacerbates the problem.

The Legacy of the Theory of High Reliability Organizations: An Ethnographic Endeavor

This article looks back over two decades of work pioneered by Todd LaPorte and colleagues, under the banner of High Reliabiilty Theory (HRT). The article revisits the American roots of the Berkeley-based group and comments on its early and decisive fieldwork choices. It revisits some of the elements that emerged through the controversy around findings and implications of HRT. It discusses the legacy of HRT and the ethographical twist given to normal operations studies. It further explains why the use of ethnographic and sociological methodologies gave new vitality to the study of high-risks organizations.

Establishing a culture of perinatal safety in a community hospital

While unsafe behavior of frontline hospital staff, primarily physicians and nurses, is sometimes the proximal cause of adverse events, the critical importance of system-wide, hospital organizational factors is now being acknowledged(1,2). These organizational factors create the "safety culture" that influences the occurrence of these proximal failures.(3) The concept of safety culture originated in high-reliability organization theory, which was largely developed by a group of social scientists at the University of California at Berkeley who studied high-risk organizations that have achieved very low accident and error rates, for example, aircraft carrier flight decks, nuclear power plants and air-traffic control systems.(4-6) Safety culture refers to the enduring and shared beliefs and practices of organization members regarding the organization's willingness to detect and learn from errors.(7).

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.

High reliability and implications for nursing leaders

To review high reliability theory and discuss its implications for the nursing leader. A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety. The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations. Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries. Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques. Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.