Applying the lessons of high risk industries to health care

High risk industries such as commercial aviation and the oil and gas industry have achieved exemplary safety performance. This paper reviews how they have managed to do that. The primary reasons are the positive attitudes towards safety and the operation of effective formal safety management systems. The safety culture provides an important explanation of why such organisations perform well. An evolutionary model of safety culture is provided in which there is a range of cultures from the pathological through the reactive to the calculative. Later, the proactive culture can evolve towards the generative organisation, an alternative description of the high reliability organisation. The current status of health care is reviewed, arguing that it has a much higher level of accidents and has a reactive culture, lagging behind both high risk industries studied in both attitude and systematic management of patient risks.

[1]  James T. Reason,et al.  Achieving a safe culture : theory and practice , 1998 .

[2]  Patrick T. W. Hudson,et al.  The Hearts and Minds Program: Understanding HSE Culture , 2002 .

[3]  James T. Reason,et al.  Diagnosing “vulnerable system syndrome”: an essential prerequisite to effective risk management , 2001 .

[4]  R. Westrum,et al.  Organizational factors associated with safety and mission success in aviation environments. , 1999 .

[5]  K. Weick.  Organizational Culture as a Source of High Reliability , 1987 .

[6]  C. Vincent,et al.  Adverse events in British hospitals: preliminary retrospective record review , 2001, BMJ : British Medical Journal.

[7]  P. Hudson,et al.  Risk assessment in clinical pharmacy , 2003, Pharmacy World and Science.

[8]  Karlene H. Roberts,et al.  The Self-Designing High-Reliability Organization: Aircraft Carrier Flight Operations at Sea , 1987 .

[9]  M O'Leary,et al.  Confidential incident reporting systems create vital awareness of safety problems. , 1996, ICAO journal.

[10]  G. Teasdale.  Learning from Bristol: report of the public inquiry into children's heart surgery at Bristol Royal Infirmary 1984-1995 , 2002, British journal of neurosurgery.

[11]  Jop Groeneweg,et al.  Promoting safety in the oil industry. The Ergonomics Society Lecture Presented at the Ergonomics Society Annual Conference, Edinburgh, 13-16 April 1993 , 1994 .

[12]  James T. Reason,et al.  Cognitive failures and accidents , 1990 .

[13]  R. Westrum.  Cultures with Requisite Imagination , 1993 .

[14]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[15]  S. Bennett.  Beyond Aviation Human Factors , 2003 .

[16]  G. Braithwaite.  Attitude or Latitude?: Australian Aviation Safety , 2001 .

[17]  T. L. Porte.  High Reliability Organizations: Unlikely, Demanding and At Risk , 1996 .

[18]  T. Ganiats.  Human Error in Medicine , 1995 .

[19]  L.W.D. Cullen,et al.  The public inquiry into the Piper Alpha disaster , 1993 .

[20]  E. Ackermann.  The Quality in Australian Health Care Study. , 1996, The Medical journal of Australia.

[21]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .