Most of the high reliability organization characteristics place emphasis on preparedness because the organizations operate in dynamic and complex environments. Some of the organizations that could employ some of the HRO characteristics are healthcare facilities, the aviation industry, and the military organizations. Since the environments for the mentioned organizations could potentially make them more susceptible to various safety risks, the management of these organizations usually creates situational measures, as well as look at every challenge independently. For a HRO characteristic such as preoccupation with failure, it implies that the management is always looking at the potential of a failure happening (Erp, 2015). Even when failures do not occur, the management, as well as the relevant stakeholders, is not complacent. Some of these characteristics and how they affect the performance of HRO organizations could create potential tensions with the concept of accountable care. For example.
Accountable care, in relation to the healthcare sector, means that the provision of services needs to adhere to certain best practices. Most of the time, nurses are expected to follow evidence-based practices to address the healthcare needs of the patients. However, HRO characteristics, especially that of the reluctance to simplify operations, mean that some of the evidence-based practices could be ignored. HRO characteristics mainly look at the present situations, and how the future may unfold; that certain aspects are constantly changing, and therefore, the past ways of doing things may not be applicable to the present and future contexts (Patient Safety Network, 2019). For example, technology is constantly evolving, and there is always pressure on healthcare facilities to embrace it. While the nursing profession has always improved because of research leading to evidence-based practices, nurses are always in a dilemma when, for instance, they are reminded or pressured to focus on only current healthcare practices.
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An example of HRO in healthcare, high-reliability characteristics can be seen in the high-risk setting of the intensive care unit. With patient care being highly complex, there is a heightened potential for the occurrence of medical errors and harm to critically ill patients. As such, by the use of organizing principles of high reliability, such as the development of capabilities to cope with unprecedented events, care is improved in the ICU. Also as mentioned, reluctance to simplify matters in the critical care center is also a principle for the healthcare sector as an HRO whereby the medical personnel avoids the tendency to perceive issues as dismal, and as those that can be explained away . However, when operations are simplified in other areas in the healthcare sector, it means that nurses are expected to follow certain procedures when administering healthcare.
With HRO characteristics, little emphasis may be placed on procedures, and consequently, organizations may embrace a pragmatic style of operations. Pragmatism creates conflict, especially in relation to the reporting procedures. HRO characteristics tend to create the perception that people closest to a specific scenario or doing a particular task are best informed or are the most aware of issues affecting that task. In particular, the HRO characteristic related to this perception is deference to expertise; it is not necessarily the people with knowledge who are consulted to explain or solve certain situations; rather, people closest to the situations are perceived to be more prolific (Mellor et al., 2015). Such a perception may create potential tensions and conflicts in healthcare organizations. For accountability in healthcare organizations, the junior employees are expected to report to the senior managers or are supposed to wait for instructions from their seniors before carrying out certain operations. However, the deference for expertise HRO characteristic may make junior employees disregard instructions from their superiors, and come up with solutions depending on the present situations and contexts. As another example of HRO in healthcare settings, organizations are designed to focus on continuous improvement. This is a factor that highly depends on the behavior of leaders. Leadership that supports collaborative learning converts a healthcare facility into a learning environment, to the extent of listing organizational development in the strategic plan ( Vogus & Singer, 2016).
Services such as testing healthcare tools like root cause analysis checklist and climate and safety culture surveys to enhance reliability positions such an organization is a highly reliable one. High reliability organizations in healthcare are attentive to the culture, cognition, and the systems they develop. They are systems that accommodate reporting of all kinds of failures and profiles risk so that they can elucidate on what is important and if there are take always that comes with the misses. Consequently, this factor is combined with a reporting culture whereby leadership emphasizes the engagement, which in turn increases situational mindfulness. Since relationships and infrastructure defines the social processes in an organization, the highly reliable organizations are a great contributor to organizational safety.
In conclusion, HRO characteristics could create potential tensions with the concept of accountable care in healthcare organizations. While accountability emphasizes procedures, HRO characteristics emphasize on pragmatism, coming up with solutions depending on the situations. Deference to expertise may conflict with accountability in the sense that junior employees may overlook the instructions of their superiors and create solutions depending on the situations in which they find themselves. Lastly, HRO characteristics may create a dilemma for healthcare workers regarding whether they should adhere to the evidence-based practices or disregard them and embrace the current ways of administering care within the healthcare facilities. Most importantly, reliability professionals depict a deep commitment to testing the organizational systems reliability. They developing their professional skills in accordance with the problems that emerge all the time and formulate responses that can address the problems. This may be through continuous development, avoidance of simplification in some constructs of healthcare and also updating of performance capabilities.
References
Erp, R. A. L. (2015). The organization of safety management: implementing high reliability principles in hospitals (Master's thesis, University of Twente). https://pdfs.semanticscholar.org/dec1/efc89588b6ae60fa00e77957c51cc03b3b3a.pdf
Mellor, N., Wilday, J., Lunt, J., & Holroyd, J. (2015). High reliability organisations and mindful leadership. In Hazard 25, Symposium Series (Vol. 160, pp. 1-6).
Patient Safety Network. (2019). “ High Reliability” https://psnet.ahrq.gov/primer/high-reliability
Vogus, T. J., & Singer, S. J. (2016). Creating highly reliable accountable care organizations. Medical Care Research and Review , 73 (6), 660-672.
