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Our goal at CPH is to become a Highly Reliable Organization where every one of us begins to view errors as opportunities for improvement.  And where each error represents a challenge to identify process changes that will prevent that error from ever happening again.

What is an HRO?

A High Reliability Organization (HRO) is an organization that succeeds in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.

Aircraft carriers, air traffic control, commercial airlines, and nuclear power plants are some examples of HROs. Central Peninsula Hospital is also adopting the five principles of HROs to ensure we deliver the highest levels of quality and safety, while preventing medical errors. • Associates in HROs are constantly searching for the smallest indication that the environment or a key safety process has changed in some way that might lead to failure if action is not taken to resolve the problem.

What are the common principles of an HRO?

Preoccupation With Failure

Everyone is aware of and thinking about the potential for failure. People understand that new threats emerge regularly from situations that no one imagined could occur, so all personnel actively think about what could go wrong and are alert to small signs of potential problems. The absence of errors or accidents leads not to complacency but to a heightened sense of vigilance for the next possible failure. Near misses are viewed as opportunities to learn about systems issues and potential improvements, rather than as evidence of safety.

Reluctance to Simplify

People resist simplifying their understanding of work processes and how and why things succeed or fail in their environment. People in HROs* understand that the work is complex and dynamic. They seek underlying rather than surface explanations. While HROs recognize the value of standardization of workflows to reduce variation, they also appreciate the complexity inherent in the number of teams, processes, and relationships involved in conducting daily operations.

Sensitivity to Operations

Based on their understanding of operational complexity, people in HROs strive to maintain a high awareness of operational conditions. This sensitivity is often referred to as "big picture understanding" or "situation awareness." It means that people cultivate an understanding of the context of the current state of their work in relation to the unit or organizational state—i.e., what is going on around them—and how the current state might support or threaten safety.

Deference to Expertise

People in HROs appreciate that the people closest to the work are the most knowledgeable about the work. Thus, people in HROs know that in a crisis or emergency the person with greatest knowledge of the situation might not be the person with the highest status and seniority. Deference to local and situation expertise results in a spirit of inquiry and de-emphasis on hierarchy in favor of learning as much as possible about potential safety threats. In an HRO, everyone is expected to share concerns with others and the organizational climate is such that all staff members are comfortable speaking up about potential safety problems.

Commitment to Resilience

Commitment to resilience is rooted in the fundamental understanding of the frequently unpredictable nature of system failures. People in HROs assume the system is at risk for failure, and they practice performing rapid assessments of and responses to challenging situations. Teams cultivate situation assessment and cross monitoring so they may identify potential safety threats quickly and either respond before safety problems cause harm or mitigate the seriousness of the safety event.