NUR 674 Describe the elements necessary in creating a high-reliability organization (HRO)?

NUR 674 Describe the elements necessary in creating a high-reliability organization (HRO)?

NUR 674 Describe the elements necessary in creating a high-reliability organization (HRO)?

High Reliability Organizations (HROs) are organizations that achieve safety, quality, and efficiency goals by employing 5 central principles: (1) sensitivity to operations (ie, heightened awareness of the state of relevant systems and processes); (2) reluctance to simplify (ie, the acceptance that work is complex, with the potential to fail in new and unexpected ways); (3) preoccupation with failure (ie, to view near misses as opportunities to improve, rather than proof of success); (4) deference to expertise (ie, to value insights from staff with the most pertinent safety knowledge over those with greater seniority); (5) and practicing resilience (ie, to prioritize emergency training for many unlikely, but possible, system failures).

A high reliability organization (HRO) is an organization with predictable and repeatable systems that support consistent operations while catching and correcting potentially catastrophic errors before they happen. High reliability organizations display consistent characteristics. One common thread across these characteristics is a constant state of awareness to recognize errors quickly and intervene before they become catastrophic and impact safety HRO experience improvements in safety culture, including improvement in safety attitudes and an increase in safety success story reporting. HRO also bring about significant improvement in communication, awareness, and working relationships, reductions in serious safety event.

As a nurse administrator you must always as the elements in the for front of your practice. For examples always looking at human factors, how to relate with world around us and how learning more about how we work and interact and design process that take the human factor into account; improving situational awareness; encourage that finding and fixing problems is everyone responsibility. Leader can round with staff giving more positives feedback as compared to negatives feedback, conducting huddles, and modeling he expected behaviors.

According to the Health Catalyst website, “the necessary pieces for developing and sustaining a culture and system that delivers safe, highly reliable care are strong effective leadership, a culture of safety, and an accessible learning system” (2018). A healthcare organization needs to have multiple things align to become a high-reliability organization. Some of these include effective leadership at the senior and local level, cultural maturity and a culture of safety, and an environment of continuous learning (HealthCatalyst, 2018). What is so important about creating a high-reliability organization is to live by what you “preach” or lead by example. One must truly believe in the principles that embody a high reliability organization. One way a leader can influence a team is by rounding on units and “should conceive of their rounding as all-inclusive, rounding on both patients and teams and covering all the key topics of interest, including safety, quality, experience, engagement, and efficiency” (). Rounding will allow the leaders to be seen on the unit and give the opportunity to show that the safety culture and accountability expectations are maintained. Other ways that leaders can use to execute these elements into an organization are to start with the hiring process and hire people who can answer questions about making a culture of safety a priority. For instance, “human resource departments should screen candidates using behavioral-based questioning that evaluates candidates’ commitment to safe, high-quality, patient-centered care” (). This screening will give leaders an idea of where the candidates sits when it comes to a culture of safety. Another opportunity for leaders to create a high reliability organization is to hold daily safety huddles in the morning. One thing about the organization that I am doing my clinicals at is that they do these daily huddles every morning with each unit checking in virtually going over the previous 24-hour safety issues and what was done to rectify each situation. They have been shifting and focusing on making the Advocate Aurora organization more of a “Just Culture” and this is one way they incorporated the safety aspect.

HRO’s and quality and safety are related because it is bringing a culture of safety to an organization which will then spill over into the quality of the organization. If safety issues arise, quality must get involved to figure out next steps: do policies need to be changed, does more education need to be done, is there a different, more beneficial way to execute something. Safety and quality go hand in hand with a high reliability organization.



Clapper, Craig & Merlino, James & Stockmeier, Carole. (2019). Zero harm: how to achieve patient and workforce safety in healthcare. [Books24x7 version] Available from

Health Catalyst. (2021, December 18). High-reliability organizations in Healthcare: Framework. Retrieved June 26, 2022, from

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A high-reliability organization (HRO) has successfully avoided disasters despite a high level of risk and complexity. HROs are the fundamental characteristics of a goal that modern health care organizations should strive for as an example. HROs are organizations that use five fundamental concepts to accomplish safety, quality, and efficiency goals. These concepts are sensitivity to operation, reluctance to simplify, preoccupation with failure, deference to expertise and practicing resilience (Veazie et al., 2019).  These concepts build a foundation for excellence, however implementing these concepts can be hard due to barriers in organizational level.

HROs are distinct organizations because they attempt to improve the overall quality of attention and the staff’s

NUR 674 Describe the elements necessary in creating a high-reliability organization (HRO)
NUR 674 Describe the elements necessary in creating a high-reliability organization (HRO)

understanding of details. As a result, HROs look for strategies to respond to potential problems. HROs are successful organizations continually being corrected and rebuilt (Mousavi et al., 2019). HROs understand the hospital’s safe atmosphere and development work. Leaders can identify whether a change has improved by notifying healthcare of issues, errors, and accidents and by allocating resources to more reliable and accurate methods of detecting risk, errors, and injury.  The approach that a nurse administrator can use to help an organization implement those principles by generating support for achieving zero-harm goals, fostering a suitable regulatory framework, and adopting a rigorous systems integration culture. Nursing is the principal leader in health care organizations responsible for ensuring patient safety and delivering high quality. Nurses are encouraged to recognize possible patient harm and recommend ways to improve (Riley, 2019). Learning HRO principles and procedures for high dependability is a crucial opportunity for nursing leaders.

On the contrary, leadership fosters open communication and the ability to get input from nurses and other frontline personnel. Practical leadership assessments are crucial to developing and maintaining a high-reliability company. Nurse leaders in HROs constantly push and develop themselves and their problem-solving abilities.

Mousavi, S. M. H., Jabbarvand Behrouz, M., Zerati, H., Dargahi, H., Asadollahi, A., Mousavi, S. A., Ashrafi, E., & Aliyari, A. (2019). Assessment of high reliability organizations model in farabi eye hospital, tehran, iran. Iranian Journal of Public Health, 47(1), 77–85.

Riley, W. (2019). High reliability and implications for nursing leaders. Journal of Nursing Management, 17(2), 238–246.

Veazie, S., Peterson, K., & Bourne, D. (2019). Evidence brief: Implementation of high reliability organization principles. In PubMed. Department of Veterans Affairs (US).

I appreciate your post and the discussion to the concepts of an HRO. The ability for and HRO organization to be pre-occupied with failure is one concept that fascinates me and was a difficult concept for staff to grasp. When my organization moved to and HRO model and high reliability concepts most staff felt it was an option to find fault and identify failures in a punitive fashion.  Through leadership improving communication and identifying the process was to help the organization to strive to understand the culture, identify gaps and prevent errors by identifying practices that could be unsafe (Fencl et al., 2021).  As you discussed an HRO is a distinct organization the strategies to have higher quality and provide safter care, through the processes you discussed. Safety huddles, blame free reporting, a supportive culture of high reliability does not just happen it is built and needs to be fostered and nurtured to grow as it nurses don’t have a desire to speak up (Fencl et al., 2021). Clinical nurses who routinely identify and report unsafe conditions bus have trust tin their leaders that the errors will not be punitive yet a growing opportunity for the nurse and organization. Leaders hold the responsibility to lead the way and enable the process for it to be successful and create a safter arena for our patients.

Fencl, J. L., Willoughby, C., & Jackson, K. (2021). Just culture: The foundation of staff safety in the perioperative environment. AORN Journal, 113(4), 329–336.