October 31, 2019

Healthcare HROs Unlocked: Part 2

As a continuation of Part 1 of our Healthcare HROs Unlocked series, we will begin to deep dive into specific aspects of High Reliability Organizations. In the study, Managing the Unexpected, Karl Weick and Kathleen Sutcliffe defined an HRO as an organization that functions in a complex and hazardous environment with a rate of mishap and error much lower that expected (Weick & Sutcliffe, 2001). HRO organizations are not so risk adverse that they attempt to be error free, but they are so risk aware, they can anticipate when there is potential for error and when it occurs. HROs can recover quickly based on training and a proactive position geared towards containment. Furthermore, the best HROs are taking this a step further by addressing the errors that occurred by deep diving into the situation, evolution, or procedure, to find what caused the error, when the error occurred, where the error occurred, how the error occurred, and often who caused the error.

At this point, I would caution the readers to understand, that the “WHO”, does not necessarily mean a specific individual, but the source of the error from a human factor’s standpoint (there will be more regarding this point later in the series). 


In preparation of evaluating the ability to become or achieve a High Reliability Organization culture, an organization must consider certain principles that help define HROs. The most commonly held principles of HROs are:


Principles of High Reliability Organizations
Principles of Anticipation: Principles of Containment:
1.     Preoccupation with Failure and It’s Causes 1.     Commitment to Resilience
2.     Reluctance to Simply Interpretations 2.     Deference to Expertise
3.     Sensitivity to Operations

(Gillingham, Corbridge, Warner, Shaub, Hoffman, 2016)


Many healthcare organizations have made great strides in an effort to become an HRO, with improved education and continued training, at both educational institutions training new medical staffs and administrators, and regular refresher training at healthcare facilities. The principles of High Reliability Organizations can transform one’s healthcare facility to a highly resilient, proactive healthcare organization that can recover from the inevitable errors that will take place; whether through complacency, human error, mechanical error, or simple negligence. In the third part of the series, COORS will begin to break down the first principle, Preoccupation with Failure and It’s Causes.



  1. Karl Weick and Karen Sutcliffe, Managing the Unexpected: Assuring High Performance in an Age of Complexity (San Francisco: Jossey-Bass, 2001).
  2. RDML Bruce Gillingham, (MD), MC, USN; LT Joshua Corbridge, MSC, USN; CAPT Howard Warner III, USN; CAPT (ret) Curtis Shaub, USN; LCDR (ret) Richard Hoffman, (Ed. D), USN; High Reliability Health Care: Lessons From the Fleet (May 2016)


About the Author:

LCDR Stephen J. Hartz, MS, MBA, CBA is currently serving within the Directorate for Integrated Warfare and is in the process of retiring from the Navy after 20 years of service.  He is a qualified Combat Helicopter Pilot and Surface Warfare Officer. Steve has spent much of his military career learning and teaching risk mitigation and resource management at every level, to include being an honors graduate of the Naval Aviation Safety School, a squadron Aviation Safety Officer, and Safety Officer of the east coast Helicopter Fleet Replacement Squadron. Steve holds his PMP and LSSGB certifications. Steve’s last active duty flying assignment was as the Officer-in-Charge of the Whidbey Island Search and Rescue Unit, the Department of Defenses number one Search and Rescue Unit in the world, conducting over 70 real world complex rescues a year, including dozens of trauma one medical rescues within the Cascade and Olympic mountain ranges.

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