High-Reliability Organizations: Preoccupation with Failure and Deference to Staff Expertise

High-reliability organizations are “preoccupied with failure,” said Jacque Mitchell, CPHRM, FASHRM, ARM, CPHQ, risk manager, Sentara Norfolk (Virginia) General Hospital, describing one of the characteristics of healthcare organizations that achieve high levels of reliability in patient safety. Speaking at an October 8, 2012, session at the American Society for Healthcare Risk Management’s annual conference in Washington, DC, Mitchell, who is president-elect of the association, said that she wants “everyone in my facility to be my risk manager on the ground” so that they identify safety hazards and report any concerns to the risk management department. Another characteristic of a high-reliability organization is leadership’s deference to the expertise of its staff, said ASHRM President Mary Anne Hilliard, B.S.N., Esq., CPHRM, chief risk counsel and vice president of safety and patient experience, Children's National Medical Center (Washington, DC). In a video shown to all new staff at the children’s hospital, the organization’s leaders tell employees that “you have my permission to speak up about your safety concerns,” said Hilliard, commenting that the message is “crazy powerful.”