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High-Reliability Organizations

Updated: Jan 26

It's easy to claim to be a High Reliability Organization (HRO), but much harder to live it. Whatever type of healthcare organization or group you lead or work within, it is by definition high-risk and complex. The concept of High Reliability Organizations refers to those entities that consistently operate with a high level of performance and consistency, usually in fields where the consequences of failure can be catastrophic. In healthcare, HROs contribute to many aspects of quality and patient and staff safety.


Key principles of high reliability organizations:


  • Preoccupation with failure: HROs are vigilant, proactive, and protective in regards to failures themselves, error reporting systems, and root cause analysis processes.

  • Reluctance to simplify: In healthcare, we can't just make things simpler. Each aspect of healthcare is complex, and the combination and cross-dependence of clinical, financial, and operational challenges expounds upon this. HROs need to embrace the complexity of their systems and recognize the need for careful consideration and analysis of such.

  • Sensitivity to operations: HROs prioritize front line staff and their actual lived experiences, depending on their insights and feedback to identify challenges and enhance operations.

  • Commitment to resilience: There will always be unexpected challenges and failures. HROs build a culture of resilience and can quickly adapt, overcome, and recover from these failures.

  • Deference to expertise: Leaders of HROs defer authority for decision-making to those with the most relevant knowledge and experience.

  • Cultural emphasis: Although culture takes time to build and change, it is the cornerstone of a true HRO. Cultures that build upon the principles above create an open environment where everyone is committed to continuous improvement.


Common pitfalls and barriers to real high reliability:


  • Lack of clear vision, collaboration, and communication: Leadership must articulate a clear vision for high reliability and enable organization-wide collaboration and communication that allows for it.

  • Resistance to learning from errors: HROs must acknowledge their failures and learn from them. In fact, this may be the cornerstone of high-reliability groups. Leaders who create an environment where staff are hesitant to report errors and near-misses will not succeed. Fostering a just culture, where errors are viewed as opportunities for growth, is essential to cultivating the individual and cultural resiliency needed for high reliability.

  • Overemphasis on short-term goals: Leaders dedicated to creating HROs must not compromise on long-term goals for short-term results. Pressures to meet short-term financial or operational goals can lead to cutting corners, overlooking potential risk, and neglecting the foundational work required for sustained, long-term excellence.

  • Failure to prioritize an employee-first mentality: We know that stressed and fatigued workers without clear vision are more prone to errors. HRO leadership must continuously assess and address moral injury, work-life balance, and mental health of their teams. Don't forget that individual and group resiliency are closely intertwined.


HROs are skilled at navigating through complex challenges with resilience and precision. While creating a true HRO may be difficult and take time, we believe that it is the only option for healthcare groups. HRO principles result in significant long-term benefits for the organization, its leaders, and staff.


Team Black Cloud can help you assess your organization and design and implement a plan to improve your group's performance, consistency, and culture. Together, let's work towards high reliability in all healthcare organizations. Contact us today!

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