Leading your organization to high reliability.

Theory specifics High reliability has generated much interest from healthcare leaders in recent years because they want to know how to halt the alarming rate of errors and preventable complications and develop systems that are safer for patients. High reliability organization theory (HROT) is a framework describing characteristics of highrisk yet safe systems that was developed from research conducted in nonhealthcare systems, such as nuclear submarines, aircraft carriers, and aviation. In these systems, a small slip or error could lead to a cascade of nonlinear responses resulting in a catastrophic event. Patient-safety researchers have studied the strategies used to prevent errors in these nonhealthcare systems and considered whether the lessons learned could be translated to healthcare settings.1–5 In his recent book, Why Hospitals Should Fly, aviation safety expert John Nash argues that high reliability within healthcare settings is achievable if leaders embrace the lessons learned in other high-risk settings.6 HROT describes five characteristics of highreliability systems, including preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise.7 (See Table 1 for tips on how to recognize high reliability characteristics.) Within these highly reliable systems is a unique teamwork culture called a culture of safety.8 An organization’s culture of safety is the result of shared values and behavior that demonstrate communications based on mutual trust, agreement on the importance of safety, and confidence in the ability to prevent errors through use of known safety practices.