Cincinnati Children’s Hospital in Ohio provides the following summary of the five key characteristics of a high reliability organization:
- Preoccupation with Failure: Everyone is focused on errors and near-misses, learning from them and figuring out how to prevent them from happening again. Attention to detail is crucial. Finding and fixing problems is everyone’s responsibility and is encouraged and supported by leadership.
- Reluctance to Simplify Interpretations: Requires constantly asking the “why” question and inviting others with diverse experience to express their opinions. The belief is that the more you’re immersed in something, the harder it is for you to objectively observe and question things that need questioning.
- Sensitivity to Operations: An ongoing concern with the unexpected. Hallmark actions include closing loopholes in processes where there is potential for patient harm, maintaining situational awareness, developing teams that speak up and paying attention to the frontline — which in hospitals is primarily nurses, patient care attendants, techs, and support staff.
- Commitment to Resilience: The concept that things will go wrong that we can’t predict; mistakes will be made, and we will get into trouble. But we will quickly identify issues and have structures in place so we can immediately respond and minimize the harm. Errors won’t disable us.
- Deference to Expertise: Finding and using experts for the given problem in the given time. More specifically, it means recognizing that those closest to the frontline are the experts and empowering them to make decisions when a critical issue arises results in quicker mitigation of harm.
(Cincinnati Children’s developed these five key characteristics from research published in 2001. An abstract of that research is available online at http://tinyurl.com/hy3dxmt.)