Aircraft carriers, air traffic control systems and nuclear power plants operate with high reliability and carry on delivering their demanding activities in an almost complete absence of catastrophic failures.1 This concept of high reliability is attractive for healthcare which is now considered to be a high hazard and high risk industry for both patients and workers.2
The essence of High Reliability Organising (HRO) is a set of principles that enable healthcare professionals and organisations to focus attention on emergent problems and deploy the right resources to address them.3 It is also a dynamic process for pursuing perfection; constantly seeking to improve reliability, intervening to prevent errors and recovering quickly if they occur.4
According to AHRQ, the mindset of high reliability is supported by five characteristic ways of thinking: Preoccupation with failure, reluctance to simplify explanations for operations, successes and failures, sensitivity to operations (situational awareness), deference to frontline expertise and commitment to resilience.5 These HRO processes ultimately lead to a state of collective awareness, mindful action and reliable performance.4
We have condensed these processes into a framework that sets Zero Harm6 for both patients and caregivers as its core element. After all, healthcare professionals live by the motto primum non nocere – first, do no harm.7 Our second core element is Zero Waste. Not only does HAAD emphasise quality and patient safety but also calls for efficiency and strengthening processes to reduce wasting supplies, equipment, ideas and energy.8 The framework also considers proactive (anticipation) and reactive (resilience) approaches in building high reliability.9
We believe that both patients and the general public, healthcare professionals and organisations all benefit from these learning opportunities in approaching Zero Harm and Zero Waste. Hence, we deliver quality and safety orientated conferences, seminars and workshops that are framed by the HRO concept.
- Reason J. Human Error: models and management. West J Med. 2000;172(6):393–6.
- The Joint Commission. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Oakbrook Terrace, IL: The Joint Commission; 2012. http://www.jointcommission.org/.
- Christianson MK, Sutcliffe KM, Miller MA, Iwashyna TJ. Becoming a high reliability organization. Crit Care. 2011;15(6):314.
- Sutcliffe KM. High reliability organizations (HROs ). Best Pract Res Clin Anaesthesiol. 2011;25(2):133–44.
- Agency for Healthcare Research and Quality (AHRQ). High Reliability [Internet]. [cited 2017 Apr 6]. Available from: https://psnet.ahrq.gov/primers/primer/31/high-reliability.
- Chassin MR, Loeb JM. High-Reliability Health Care: Getting There from Here. Milbank Q. 2017;91(3):459–90.
- Spath P. Introduction To Healthcare Quality Management. Chicago, Illinois (USA): Health Administration Press; 2009.
- Health Authority Abu Dhabi (HAAD). Policy for Quality and Patient Safety. Abu Dhabi; 2017. http://www.haad.ae/.
- Oster CA, Braaten JS. High Reliability Organizations: A Healthcare Handbook for Patient Safety & Quality. First Edit. Indianapolis, IN: Sigma Theta Tau International; 2016.