High Reliability Organization

High Reliability Organization (HRO)

Organizations that operate in a complex environment with many risk factors for accidents can avoid catastrophes by becoming high reliability organizations (HRO). Models for high reliability organizations are drawn from aspects of air traffic control, aircraft carrier operation, and nuclear power generation. These types of organizations use complex processes to manage complex technologies and work activities to avoid failures that produce grave or far-reaching consequences. Healthcare organizations see the benefits of this approach and are now searching for guidance on how to establish a baseline and close the gaps to become high reliability.


Defining exactly what constitutes a high reliability organization is difficult and has been the subject of many debates. Importantly, organizations that seek high reliability are not measured by their safety scores or accident rates, but rather by their intense collective efforts to manage highly risky technologies or work processes. As a result, there are a set of principles that guide the development of high-reliability organizations. A high reliability organization is:

1. Preoccupied with the potential for failure.
2. Resistant to the temptation to simplify observations and experiences.
3. Sensitive to operations.
4. Committed to resiliency.
5. Deferential to expertise.


The process of developing a high reliability organization is evolutionary and expectations are that reasonably mature elements of leadership, safety culture and process improvement are in place before beginning the initiative. Many organizations may need to work on each of these fundamental areas before a formalized HRO implementation can be initiated. Once those maturity requirements are achieved, organizations can expect to work on changing in these dimensions:

1. Development of leadership commitment to the ultimate goal of zero patient harm.
2. Incorporation of all the principles and practices of a safety culture
3. Adoption of robust process improvement tools and methods


Our team has developed a program to support our client's HRO initiatives by providing the strategic and technical guidance to develop the five high reliability principles across their organizations. Some of the areas of consulting and training support we provide are:

  • Baseline assessment based on a 14-Point HRO Maturity Scaling Matrix
  • Leadership and management-level HRO training
  • Best-practice Process Improvement deployment strategy and training
    (Lean, Six Sigma, Theory of Constraints)
  • HRO Program Management & Implementation Support
  • Improvement Project Portfolio Management


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