The theory of the High-Reliability Organization (HRO) was developed to improve safety in the health care service. HRO is defined as an organization that succeeds in maintaining a low level of errors and aims to achieve zero harm level in situations, where the average institution expects to have failures due to risk factors. In this paper, the characteristics of HRO and the five principles implied in its theory will be discussed.
HRO seeks to stabilize its organizational and operational system; predictability could ensure the permanency of high-level service standards and minimize errors. As medical care specialists argue, an error is a result not of a single physician, nurse, or administrative staff member, but of the tfallacies of the entire system. In order to improve safety, the whole culture and approach of the organization’s members should change. Each stage of the health care service performance must be quantified, measured, analyzed, predicted, and managed. The achievement of efficiency goals by HRO employs five central principles:
- Sensitivity to operations;
- Reluctance to simplify;
- Preoccupation with failure;
- Deference to expertise;
- Practicing resilience.
Although the ideal model for HRO is operating in error-free mode, in practice, this state is still hardly achievable. However, the intention and efforts remain a priority for the professionals working in HRO. As Sutcliffe et al. argue, the specialty of HRO is not error-free performance, but the resistance to errors. Possible failures do not considerably affect patients’ outcomes; thus, HRO is not error-free but harm-free.
For nurses working in HRO, particular roles and responsibilities become of utmost importance. Nurse professionals would need to have a high level of education to ensure understanding and possible correction of physicians’ prescriptions instead of blindly following them. Thus, nurses’ responsibilities could often intersect with physicians’ functions that would require certain leadership qualities from the nurse. In addition, nurses in HRO must be prepared for interpersonal collaboration to provide high-quality patient-centered care.
References
Press Ganey Associates LLC. Leading to zero: the journey to high reliability [Video file]. 2017. Web.
Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of high-reliability organization principles [Internet]. Veterans Health Administration, Health Services Research & Development
Service [cited 2020]. Web.
Sutcliffe KM, Paine L, Pronovost PJ. Re-examining high reliability: actively organising for safety. BMJ Quality & Safety, 2016;26(3): 248–251.