I was recently asked to give a talk on High Reliability Organizations to our foundation and marketing teams. Normally this would be a relatively straightforward request for me, as I have several prepared or "canned" talks on this subject. However, I was asked to talk about how the HRO principles apply to non-clinical areas. To be more specific, our foundation and marketing teams wanted to learn how to apply HRO principles to think differently and work more effectively at their jobs. So, I spent the allotted time (about 20 minutes) without mentioning safety at all.
The question really is whether HRO principles can be applied so that organizations can perform at their best and not just at their safest. In my opinion, High Reliability Organizations can also be called "High Performing Organizations." The five characteristics, which include Deference to Expertise, Preoccupation with Failure, Sensitivity to Operations, Commitment to Resilience, and Reluctance to Simplify (and I previously added a sixth characteristic, Comfort with Uncertainty and Chaos to this list), help organizations to operate at the highest level of performance. I have studied "high performing organizations" in a variety of different industries, including health care, and I consistently find that these organizations operate at the highest levels of safety, efficiency, consistency, and success.
As an example, I mentioned the book Turn The Ship Around! by David Marquet. I've mentioned this book a couple of times in the past (see "Classic Rookie Manager Mistakes", "The definition of power is the transfer of energy...", and "The power of empowerment"), and if you haven't read it yet, it's definitely worth a look. Marquet assumed command of the USS Santa Fe, a nuclear-powered submarine which was perhaps one of the worst commands in the fleet. Using what you will recognize essentially as High Reliability Organizations leadership principles, Captain Marquet turned the USS Santa Fe into one of the best commands in the fleet. Prior to Captain Marquet, the reenlistment rate on the USS Sante Fe was well below the average for the rest of the Navy (only three members of the crew reenlisted the year before Captain Marquet took over - by the time Captain Marquet finished his tour as the Commanding Officer (CO), thirty-three sailors signed up for another tour of duty, far above the Navy's average). Similarly, on average, about two or three officers on a submarine will ultimately go on to become CO's. During Captain Marquet's tenure, nine out of his fourteen officers eventually became submarine CO's.
One of Marquet's key concepts is "pushing authority to information". In most organizations, decisionmaking authority is based upon rank or hierarchy. However, most of the key information necessary to make those decisions is at the lowest ranks, i.e. on the front-lines. In most organizations, information is pushed to authority (up the chain of command to those who have the authority to make decisions). Marquet "flipped the script" so that authority was pushed to information - in other words, he gave decisionmaking authority to those individuals on the front-lines who had access to the information needed to make those decisions. Sound familiar? It's exactly what High Reliability Organizations would call Deference to Expertise!
As you read Marquet's book, you will recognize several of the key principles that define highly reliable organizations. Similarly, if you study high performing organizations, you will find that almost all of them are also High Reliability Organizations.
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