TY - JOUR
T1 - Becoming a high reliability organization
AU - Christianson, Marlys K.
AU - Sutcliffe, Kathleen M.
AU - Miller, Melissa A.
AU - Iwashyna, Theodore J.
N1 - Funding Information:
This work was supported by the National Institutes of Health via K08 HL091249 (TJI) and by the NIH/NHLBI T32: HL 07749-17 (MAM). We thank Andre Amaral and two anonymous reviewers for constructive comments on previous drafts.
PY - 2011/12/8
Y1 - 2011/12/8
N2 - Aircraft carriers, electrical power grids, and wildland firefighting, though seemingly different, are exemplars of high reliability organizations (HROs) - organizations that have the potential for catastrophic failure yet engage in nearly error-free performance. HROs commit to safety at the highest level and adopt a special approach to its pursuit. High reliability organizing has been studied and discussed for some time in other industries and is receiving increasing attention in health care, particularly in high-risk settings like the intensive care unit (ICU). The essence of high reliability organizing is a set of principles that enable organizations to focus attention on emergent problems and to deploy the right set of resources to address those problems. HROs behave in ways that sometimes seem counterintuitive - they do not try to hide failures but rather celebrate them as windows into the health of the system, they seek out problems, they avoid focusing on just one aspect of work and are able to see how all the parts of work fit together, they expect unexpected events and develop the capability to manage them, and they defer decision making to local frontline experts who are empowered to solve problems. Given the complexity of patient care in the ICU, the potential for medical error, and the particular sensitivity of critically ill patients to harm, high reliability organizing principles hold promise for improving ICU patient care.
AB - Aircraft carriers, electrical power grids, and wildland firefighting, though seemingly different, are exemplars of high reliability organizations (HROs) - organizations that have the potential for catastrophic failure yet engage in nearly error-free performance. HROs commit to safety at the highest level and adopt a special approach to its pursuit. High reliability organizing has been studied and discussed for some time in other industries and is receiving increasing attention in health care, particularly in high-risk settings like the intensive care unit (ICU). The essence of high reliability organizing is a set of principles that enable organizations to focus attention on emergent problems and to deploy the right set of resources to address those problems. HROs behave in ways that sometimes seem counterintuitive - they do not try to hide failures but rather celebrate them as windows into the health of the system, they seek out problems, they avoid focusing on just one aspect of work and are able to see how all the parts of work fit together, they expect unexpected events and develop the capability to manage them, and they defer decision making to local frontline experts who are empowered to solve problems. Given the complexity of patient care in the ICU, the potential for medical error, and the particular sensitivity of critically ill patients to harm, high reliability organizing principles hold promise for improving ICU patient care.
UR - http://www.scopus.com/inward/record.url?scp=83755181717&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83755181717&partnerID=8YFLogxK
U2 - 10.1186/cc10360
DO - 10.1186/cc10360
M3 - Article
C2 - 22188677
AN - SCOPUS:83755181717
SN - 1364-8535
VL - 15
JO - Critical Care
JF - Critical Care
IS - 6
M1 - 314
ER -