Re-examining high reliability: actively organising for safety
In the 15 years since To Err is Human was published,1 the US healthcare industry has worked diligently to improve patient safety. Although progress has been made in reducing hospital-acquired conditions2 and, in some cases, rates of surgical mortality,3 healthcare has not achieved broad reductions for most patient harms. In recent years, healthcare has borrowed ideas from industries that have strong safety records, including teamwork and error reporting from aviation, and process improvement techniques from manufacturing. Healthcare’s latest patient safety push is to encourage hospitals to become a ‘high reliability organisation’ (HRO).
HROs have maintained remarkable performance despite complex and risky work. These ultrasafe organisations never set out to be HROs. As Rochlin5 observed: HROs ‘seek an ideal of perfection but never expect to achieve it. They demand complete safety but never expect it. They dread surprise but always anticipate it. They deliver reliability but never take it for granted. They live by the book but are unwilling to die by it’. HROs understand that reliability is an endless journey rather than a simple destination.
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