Once again...High Reliability Organizations

It's been a couple of years since I first posted about High Reliability Organizations (HROs).  I wanted to re-visit the topic again in today's post.  HRO theory started with the analysis of three vastly different organizations - an US Navy nuclear-powered aircraft carrier (USS Carl Vinson), the Federal Aviation Administration's Air Traffic Control system, and Pacific Gas and Electric's nuclear power plant at Diablo Canyon - by an eclectic group of investigators - Rear Admiral (retired) Tom Mercer, Todd LaPorte, Gene Rochlin, and Karlene Roberts (all at the University of California at Berkeley).  Additional contributions to the HRO literature have been provided over the years by Karl Weick, Paul Schulman, and Kathleen Sutcliffe.  HROs are usually defined as organizations that somehow avoid catastrophic accidents, even though they normally exist in an environment where normal accidents can be expected to occur by virtue of the complexity of the organization and by the nature of the industry.  Examples of HROs have included flight deck operations on US Navy aircraft carriers, nuclear power plants, commercial aviation, NASA, and forest fire fighting operations. 

Interestingly enough, every single HRO has, at one time or another, has experienced catastrophic accidents.  For example, NASA has had the space shuttle Challenger and Columbia accidents, while the nuclear power industry has experienced the Three Mile Island and, more recently, the Fukushima Daiichi disasters.  Commercial aviation has become incredibly safe over the last few decades, but occasionally there are accidents that result in significant loss of life.  Even the highly acclaimed Toyota Production System (many experts have claimed that Toyota has been one of the more recent examples of a HRO) has experienced difficulties.  As such, there are certainly lessons that we, in health care, can learn from HRO's past successes and failures (see also my article "Organization-wide approaches to patient safety" published several years ago).  

Karl Weick and Kathleen Sutcliffe have written extensively on HRO principles in their excellent book entitled "Managing the Unexpected".  Weick and Sutcliffe explain that all HROs have five key organizational characteristics in common:

1. Preoccupation with failure
2. Reluctance to simplify
3. Sensitivity to operations
4. Commitment to resilience
5. Deference to expertise

Three of these organizational characteristics have been called "Principles of Anticipation" as they have more to do with prevention of errors.  These include (1) Preoccupation with failure, (2) Reluctance to simplify, and (3) sensitivity to operations.  The last two organizational characteristics are known as "Principles of Containment" as they involve minimizing the impact of an error once it has already occurred.  These include, (4) Commitment to resilience and (5) Deference to expertise. 

I have written a number of posts over the years, highlighting at one time or another each of these five organizational characteristics.  I wanted to make it easier to search this blog for older posts on what separates HROs from the rest of us.  So, in my next five posts, I will collect all of these older posts and list them in a post on each of the five characteristics listed above.