Learning from high-reliability organizations.

What does it mean to build a culture of quality? Culture refers to the attitudes, values, and behaviors of individuals when acting in a group or an environment in which individuals are encouraged to work proactively as part of a team [1]. As part of the organizational culture of medicine and radiology, individuals should feel empowered to speak up and look beyond their own boundaries to ensure safe patient handoffs between disparate care teams [2]. The concepts from management science known as high-reliability organization (HRO) design can teach us a great deal about building a culture of quality [3]. Specific examples of HROs include aircraft carriers, forest firefighting teams, and trauma centers. These groups need to be flexible and respond to a variety of complex and ever-changing situations with little to no margin of error. This requires 2 different mind-sets. The first, anticipation, focuses on preparedness and scenario planning that should allow one to think first and then act. The second mind-set is containment, which is directed at what happens subsequent to an event and is geared toward thinking while acting (or acting to allow clear thought).