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High-Reliability Organizations and Patient Safety

High-Reliability Organizations and Patient Safety

The goal of the paper is to demonstrate that high-reliability organizations can successfully function in the healthcare sector. Hospitals and clinics can develop comprehensive and appropriate measures to overcome hazardous conditions. As a result, the smoothness of the caregiving process, health promotion, patient satisfaction, and staff retention will be ensured. Drawing on reports, expert views, statistical data, and scholarly sources, it can be stated that healthcare organizations can become high-reliability bodies, which will be able to effectively cooperate in complex, ever-changing, challenging, and dangerous environments, as well as timely address failures and accidents. According to the obtained information, one can make a conclusion that the concept of high reliability attracts the upper management of healthcare providers. Despite the complexity, medical centers express their readiness to introduce necessary changes and transform their facilities to prevent adverse consequences and finally establish high-reliability organizations that meet the population’s basic health needs.

Due to the fact that organizations have hierarchical structures, work under constantly changing and challenging conditions, and face numerous kinds of production pressure, the upper management and staff prioritize safety and bear equal responsibility for operational adjustments to promote safety in their activities. Thus, this aspect has become a top priority for the entities. High-reliability organizations highlight the importance of resilience, prioritize safety over performance indicators and use systems taking into account the design and evaluation of safety.

Healthcare leaders, physicians, and nurses recognize the significance of both safety and quality during the caregiving process and agree that the establishment of high-reliability organizations can transform healthcare for the better. The main challenge of high reliability is to ensure that both aspects are met. The transformation of healthcare through the development of high-reliability programs will be successful only by means of the joint efforts of all parties involved in caregiving and the constant support provided to personnel, officials, patients, and their families. The implementation of changes will be executed in the context of effective management and establishment of accountability along with an alignment culture focused on the key safety and quality objectives set by the upper management of a healthcare facility.

In order to reach improvement and transformations, it is necessary to utilize various tools. The most common ones are Six Sigma and Lean (Mason, Nicolay, & Darzi, 2015). Their efficient implementation will ensure ongoing sustentation over time. Like other behaviors and systems, these tools operate effectively and predictably only if an entity uses the organization-wide approach directed towards helping patients at any time. Comprehensive changes, adequate management, coordinated working process, and continuous development are fully aligned with the concept of high reliability. It is often argued that these fundamental principles and “zero harm” objectives cannot be selectively pursued. Healthcare organizations can achieve high reliability only through the universal application of essential standards across the system. To make certain that both managers and subordinates support high reliability in the medical centers, it is important to devise and introduce a specific model that will emphasize leadership. As a result, all leaders should demonstrate their full commitment and focus their professional activity on safety and quality as the priority strategic purposes. In order to accelerate the transformation, they should also pay particular attention to the robust improvement of the working process and safety culture.

Minor progress has been made in healthcare toward becoming an HRO due to concerns and issues with the introduction and customization. Despite the proposed initiative, undertaken measures, and valuable knowledge derived from the experience of other high-reliability companies, healthcare leaders are not confident yet about how to properly use the acquired information and sustain efforts over time in their own entities. Healthcare systems have referred to the activities of such fields as aviation and the nuclear power industry (Wears, Hollnagel, & Braithwaite, 2015). Hence, these initiatives have proved their effectiveness in the above-mentioned areas, but no one can predict how the medical facilities will get accustomed to the concept of high reliability and how the initiatives will be implemented in the professional medical practice. Healthcare leaders express their concerns about such issues as the necessity for IT standardization, the lack of benchmarking data to measure systems, as well as the sequence of patient safety initiatives.

The lack of knowledge base, understanding of the setting itself, and attempts to adopt a system that may not fit the healthcare environment, work in the same way and follow the same principles as the aviation and nuclear power industry do, demonstrate that healthcare providers reached little progress in becoming high-reliability organizations. In reality, frontline workers possess relevant implementation knowledge focusing on the promotion of the best practice and highlighting the need for alternative distribution channels. However, it does not mean that the approach, strategy, and tactics chosen by an aviation company will fit into the medical facilities. Preoccupation with failure along with the sensitivity of leaders and subordinates to operations aimed at making a healthcare organization the high-reliability one did not produce significant progress. Reporting of boards (local and parent) forces the medical institutions to identify and assign responsibilities to the staff depending on conditions and events. Additionally, healthcare centers seek to clarify roles and information flows that will occur after the transformation. Having tried some initiatives and having got the results, leaders recognize that they are not currently where they wanted to be initially; therefore, they are to introduce something else to see differences in the outcome (Covey, 2013). The main reason for little progress in the changes towards a high-reliability organization is not the lack of knowledge about what to perform, but how to fulfill the assigned tasks and promote safety in the medical setting.

In order to become a high-reliability organization, it is crucial to weigh the positive and negative sides of this adoption and introduction. Healthcare systems should demonstrate their readiness to deliver high-quality, safe, effective, and affordable care to patients and support their family members during hard times. It is also essential to utilize relevant tools and appropriate methods to learn, show the willingness to produce changes, respond to challenges, and advance a culture of continuous improvement. Although there is a great need to embrace it, it is difficult to instill. Due to the transformation of education and healthcare, providers should always enhance their knowledge, increase expertise and proficiency, as well as pay particular attention to the safety of staff, patients, and their families (Chou & Cooley, 2018). Only in this case, the medical facilities will prosper and survive in the competitive, challenging, and ever-changing environment.

Owing to the fact that high-reliability organizations promote and emphasize a different way of thinking and performing duties, it is necessary to ensure that the specialists will not be afraid of complex tasks and demonstrate their readiness to fulfill them timely and efficiently. For the changes to bring a desirable and highly reliable outcome, it is important to provide an opportunity to every leader, manager, and patient to share concerns and secure that the issues they face are heard and properly addressed (Epstein & Buhovac, 2014). Every caregiver should be able to expose his/her views to colleagues, clients along with their family members and make certain that everything is clear.

In order to reach improvement and transform a regular entity into HRO, stakeholders including the frontline (nurses, physicians, and other providers) should simplify the working process, conduct daily check-ins, and executive rounds, use safety huddles, and organize rigorous processes for managing staff performance rewarding team and individual accomplishments. Moreover, it is necessary to embrace challenges that stretch one’s capacity as a leader, measurement errors, and near misses, as well as trended minor and major events, apply concepts of resilience and preoccupation, offer additional support to providers, take care of the patients subject to the highest risk, standardize medication concentrations to reduce medical malpractice and sustain culture, which is built on high-reliability concepts.

Regardless of patients’ health conditions and age, their role is changing; thus, they are no longer passive recipients of care. Due to technological advancements, healthcare consumers have been provided with a great opportunity to make informed choices and attend to their own health independently. Patients are also welcome to contribute to the establishment of high-reliability organizations through engagement in the design, delivery, and planning of health services. Available information granted more power to the patients thereby enabling them to positively influence the caregiving process and transformation.

The interest of payers in the development and maintenance of high-reliability organizations is evident, as the formation of this system will help to properly detect and prevent errors in high-risk, complex, and challenging conditions. Through the best practices, tools, and methods, caregivers enhance safety and quality outcomes during turbulent times. The payers, who are engaged in high-reliability organizations, take advantage of this involvement only in case their demands and needs are met. They believe that the professional work and high-quality performance demonstrated by the medical setting will ensure the smoothness of the caregiving process and favorable outcomes. Additionally, payers are not only interested in the reimbursement of funds, but also in the cooperation with leaders, promotion of safety culture, and improvement of a robust healthcare delivery process. Owing to HROs, not only medical staff gets the necessary tools to fulfill their duties, but also payers, who induce transformational changes as well as get a great opportunity to speak up regardless of systems and processes. The contribution of payers towards the transition to value-based care and establishment of high-reliability organizations is crucial; therefore, individuals are interested in changes, as they are concerned with their health, safety, and reimbursement of funds through the provided services (McGinnis, Stuckhardt, Saunders, & Smith, 2013). Before involvement in the process, payers research the issue and pay particular attention to the effective standardization of healthcare processes after the introduction of the high-reliability concept. However, this aspect can exceed the standardization and is associated with persistent mindfulness within the medical facility.

To conclude, high-reliability organizations take into consideration resilience and safety in their work, unlike the common ones, which prioritize performance indicators. Healthcare leaders recognize the importance of such aspects as quality, patient satisfaction, and safety as well as agree that transformation can bring necessary changes and enhance the way of care delivery. The main issue is to secure that both aspects are realized. The transformation into high-reliability organizations will be successful only through the joint efforts of nurses, doctors, and managers. Consequently, healthcare leaders should routinely observe the provision of direct patient care and cooperate with the medical personnel regarding the operations in which they are engaged in order to achieve a quick transformation.


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Covey, S. R. (2013). The 7 Habits of highly effective people: Powerful Lessons in personal change. New York, NY: Simon & Schuster.

Epstein, M. J., & Buhovac, A. R. (2014). Making sustainability work: Best practices in managing and measuring corporate social, environmental, and economic impacts (2nd ed.). San Francisco, CA: Berrett-Koehler Publishers.

Mason, S. E., Nicolay, C. R., & Darzi, A. (2015). The use of Lean and Six Sigma methodologies in surgery: A systematic review. The Surgeon, 13(2), 91-100.

McGinnis, J. M., Stuckhardt, L., Saunders, R., & Smith, M. (Eds.). (2013). Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press.

Wears, R. L., Hollnagel, E., & Braithwaite, J. (Eds.). (2015). Resilient health care. Farnham: Ashgate Publishing Limited.