A high-reliability organization (HRO) is an organization that is successful in avoiding catastrophes despite a high level of risk and complexity. Specific examples are air traffic control systems, nuclear power plants, naval aircraft carriers, and hospitals. In each of these cases, even a minor mistake can lead to catastrophic results.
Nonetheless, adverse outcomes in these types of organizations are very unusual. How can that be?
Fortunately, we don’t have to guess the answer. Thanks to researchers Karl Weick and Kathleen Sutcliffe and the case studies they created, we know precisely which attitudes have taken root in these “High-Reliability Organizations.” The good news is that your organization doesn’t need to deal with life-or-death risk to apply the principles that create an environment where error-free operations are the norm.
The 5 Principals of High Reliability
Preoccupation with Failure
In a high-reliability organization, everyone is continually thinking about the potential for failure. This isn’t a passive activity that comes up only when something goes wrong. Team members actively think about new threats that might emerge and situations that no one expects to occur. The absence of errors doesn’t mean that they aren’t possible; it just means they haven’t cropped up yet. Near misses don’t create a false sense of security; instead, they trigger a full investigation and the need for corrective and preventative actions.
How can you make this part of your cultural DNA? Start by never letting small failures be swept under the rug. This will require leaders to focus on the failed process, not the people who operate the process. By doing this, people become more willing to discuss flaws and defects and less incentivized to make them invisible. Errors of all types can be reduced or eliminated if every failure is given due and urgent attention.
Reluctance to Simplify
High-reliability organizations can not afford to be content with simple explanations on complicated processes. Team members understand that operations are not performed in isolation, and therefore the state of work is complex and dynamic. HROs dig into the underlying issues that drive outcomes and see every process as part of a system.
One easy way to apply this to your processes is to use the Lean technique of the 5 whys. You start with an undesirable outcome and ask why it happened. Then, take the answer and ask why again. This process is repeated until the root cause of an issue is uncovered and addressed. For example, if an order was delivered to the customer late because an incorrect shipping method was entered into the order by the service rep. The simple response is to reprimand the representative. The 5 whys may lead you to uncover a systemic training problem and the need for validation within the system.
Sensitivity to Operations
Being sensitive to operations means having a big picture understanding of current conditions, also known as situational awareness. It requires leaders to understand how processes are operating in the real world today. Thus, processes and results are seen in context, not evaluated as abstract ideals.
Gemba walks are an excellent way for leaders to gain this “ground-level” understanding by going to the place where work gets done, observing, and asking questions. In addition, building trust between front-line workers and leaders is an essential first step on the path to becoming an operationally sensitive organization.
Deference to Expertise
In a high-reliability culture, leaders believe that the people closest to the work have the greatest knowledge of the situation. When something goes wrong, expertise trumps status and seniority. While there may be a hierarchy in place, it is not the deciding factor in decisions clearly best made by the experts.
You can begin to implement this principle by first understanding who has expertise on essential subjects and who sits most closely to each process that might need improvement. It is also a good idea to employ the CQI technique of Catchball to make sure that ideas are evaluated and improved by everyone who might be in a position to add unique insight.
Commitment to Resilience
While highly reliable organizations do everything possible to prevent failure, something will inevitably go wrong. These organizations are ready to take action against unexpected events. They practice quickly assessing issues and responding to unexpected situations. They outline plans for damage mitigation and have pre-assigned roles for rapid response.
A necessary element of resilience is cross-functional collaboration because many failures happen where processes or operations meet. Teams can begin to cultivate the skill of resilience by working together and establishing reliable, consistent methods of communication. In addition, it helps when process documentation is centralized and easily accessible in an urgent situation.
The Meaning of High Reliability in Healthcare
High-reliability organizations proactively assess the strength and resilience of their safety systems and the defenses that prevent errors from spiraling out of control and leading to harm. Unfortunately, many hospitals function in mainly reactive mode. They investigate incidents in which patients have already been injured. Only then do they conduct root cause analyses and implement corrective action plans to prevent future occurrences that impact patient safety. Instilling a safety culture requires the willingness and ability to recognize and report close calls and unsafe conditions, along with an organizational capacity to act effectively on those reports to eliminate the risks they pose.
As opposed to focusing on single events, high-reliability healthcare organizations compile the results of their investigations across many harmful events and near misses to identify which of their safety systems or defenses are most in need of improvement. These evaluations lead to the development of proactive assessments of crucial safety systems (for example, those related to medication administration and infection prevention and control) so that weak spots can be identified and remedied before they pose any significant risk to patients.
Consistently demonstrating these five traits is critically necessary for organizations with complex and risky missions. But any organization that wants to deliver excellent quality and maximized customer value can live them as well.