Calling the Shots: Nursing News and Notes

What are High Reliability Organizations (HRO)?

What are High Reliability Organizations (HRO)?

Wednesday, August 30, 2017
Apply these five traits of high reliability organizations (HRO) to your practice.

Many hospitals are embracing the values of high reliability organizations (HRO), which promote patient safety and efficient healthcare delivery.

HROs are described as organizations that are known for hazardous work, yet enjoy a high level of safety over long periods of time. HROs have systems in place that make them exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors.

Four organizational characteristics of the HRO that limit accidents:

  • Prioritization of both safety and performance and shared goals across the organization
  • Culture of reliability that simultaneously decentralizes and centralizes operations allowing authority decisions to migrate toward lower ranking members
  • Using trial-and-error learning to change for the better following accidents, incidents, and near misses
  • Strategy of redundancy in behaviors, such as one person stepping in when a task needs completion.

Researchers have found a link between HROs and hardwiring certain tools, behaviors, and techniques within the organization's culture. Below are 5 common traits of HROs: 

1. Be sensitive to operations. Leaders and staff need to be constantly aware of how processes and systems affect the organization. In HROs, each employee pays close attention to operations and maintains awareness as to what is or isn't working. This concentration on processes leads to observations that inform decision-making and new operational initiatives. Nurse leaders can drive more organizational awareness through improved communication and data sharing, whether the data being shared is a patient safety metric or perception of care result.

2. Be reluctant to accept simple explanations for problems. HROs resist broad excuses. While it is beneficial to simplify some work processes, HROs recognize the risks of painting with broad strokes and failing to dig deeply enough to find the real source of a particular problem. HROs identify potential reasons for poor performance, and continue to ask more questions until they find the specific source of the problem.

3. Have a preoccupation with failure. Every employee at every level in a high reliability organization is encouraged to think of ways the work processes might break down. This sense of shared attentiveness is applicable to small inefficiencies and major failures, including medical errors. Employees are encouraged to share their concerns for potential failures, which can help create best practices across departments.

HROs also de-stigmatize failure. Medical errors that are detected and corrected before harming patients are called near-misses. HROs treat these events differently than others might. They encourage employees to come forward with near-misses and focus on which processes and safeguards work best.

4. Defer to expertise. Nurse leaders at HROs listen to people who have the most knowledge of the task at hand. Sometimes those individuals might not have the most seniority, but they are still encouraged to voice their concerns, ideas, and input — regardless of hierarchy. If leaders don't listen to staff about processes and operations within the hospital, it is practically impossible to develop a culture of high reliability. HROs redefine meetings. The best place for conversations between leaders and staff is in the work area, not in conference rooms. Managers can make rounds and receive feedback from employees, supervisors and other staff members. By observing processes and meeting with employees in their actual work space, leaders can more easily defer to employees' expertise and customs.

5. Be resilient. Leaders at HROs are prepared to respond to failures and continually find new solutions. They might improvise more, or quickly develop new ways to respond to unexpected events. HROs might experience some failures, but their resilience and swift problem solving prevents catastrophes.

Effective leadership evaluations are critical for developing and maintaining a high reliability organization. If you don't set specific and measurable goals, you can't sustain results. HROs hardwire evidence-based leadership evaluation tools, such as report cards and 90-day action plans, into their organizations and prioritize goals. Nurse leaders in HROs are constantly challenging and improving upon themselves and how they respond to problems.

Can you apply some or all of these HRO traits to your facility?

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