High Reliability Organization

Is Your Private Practice A High Reliability Organization?

As we move forward into this new era of healthcare, private practice anesthesiologists should champion every effort to become a High Reliability Organization (HRO).

HROs are defined as “organizations that succeed in avoiding catastrophes in an environment where normal accidents can be expected due to high risk and complexity.” Airline traffic control and nuclear power plants are leaders in the HRO world.

As the population continues to age, surgeries are becoming more complex. Anesthesiologists have an opportunity to bring the HRO culture into the OR with the following five principles, as described by authors Weick and Sutcliffe:

  • Preoccupation with failure and a shared attentiveness to errors and near misses. In an HRO, failure is de-stigmatized and turned into a learning opportunity. By sharing our failures, we can learn from them and prevent recurrence. Attention to detail and finding and fixing problems is everyone’s responsibility.
  • Reluctance to simplify.Labels, clichés and preconceived notions can prevent us from doing the due diligence and truly analyzing our failures. As physician leaders, we must always be asking WHY.
  • Sensitivity to operations. Become aware not only of how systems and processes work, but how they affect your organization. In an HRO, every person pays close attention to what is and is not working and maintains situational awareness to close loopholes that could result in an adverse event.
  • Commitment to resilience. HROs share a relentless obligation to identify failures and respond when failures do occur. They never give up. Instead, they find solutions and develop better evaluation tools.
  • Defer to the experts. Listen to those with the most knowledge and avoid hierarchy. Everyone’s input is valuable.

Embodying these five principles and striving to become an HRO will not only foster a culture of safety to protect our patients, but will also bring an improved performance in everything we do as anesthesiologists.