High Reliability Organization

The 5 Essential Traits of High Reliability in Healthcare

We've highlighted the five essential traits of high reliability organizations and illustrated how Readiness Rounds helps our clients achieve each one.

5 Traits of High Reliability Organizations

We’ve all heard of high reliability and have read about other industries that accomplish exceptional safety performance. While high reliability concepts are not new, the health care industry still struggles with becoming more reliable on their path to zero harm. A 2013 Becker’s article based on Quint Studer's (founder and Chairman of the Board at Studer Group) five traits of High Reliability organizations.

These five traits are also a key part of the high reliability methodology developed by Readiness Rounds. In most instances, the five traits are significantly supported by Readiness Rounds methodology and performance improvement (PI) platform. Let’s connect some dots...

1. High reliability organizations are sensitive to operations. 

Leaders and staff need to be constantly aware of how processes and systems affect the organization. In high reliability organizations, each employee pays close attention to operations and maintains awareness as to what is or isn't working. There are no assumptions. This steady concentration on processes leads to observations that inform decision-making and new operational initiatives." [Becker's]

Proactive, scheduled surveillance of key processes in areas such as medication management, hand hygiene and CAUTI & CLABSI prevention, offer increased awareness as to what is or isn’t working. Many hospitals use manual tools to survey these processes; while this is important, the manual data being collected may not be aggregated and measured, and therefore, not useable. How do you improve if you are not measuring?

2. High reliability organizations are reluctant to accept "simple" explanations for problems. 

Broad, rational excuses can be attractive when processes don't work well. But high reliability organizations resist simplifications. While it is beneficial to simplify some work processes, high reliability organizations recognize the risks of painting with broad strokes and failing to dig deeply enough to find the real source of a particular problem.” [Becker's]

These broad, rational excuses are often the result of not having a way to really see where breakdowns in protocol adherence, staff knowledge or customer service occur prior to an event or otherwise unhappy patient. Having a way to trend quality observational data and easily see trends for PI purposes can help an organization function more reliably. Of course, the data then must be acted on, which is a separate challenge.

3. High reliability organizations have a preoccupation with failure. 

Every employee at every level in a high reliability organization is encouraged to think of ways their work processes might break down. This sense of shared attentiveness is constant. It is applicable to small inefficiencies and major failures, including medical errors. Employees are encouraged to share their concerns for potential failures, which can help create best practices across departments. 

High reliability organizations de-stigmatize failure. Medical errors that are detected and corrected before harming patients are called "near-misses," and Mr. Studer says high reliability organizations treat these events differently from other hospitals. They encourage employees to come forward with near-misses and they focus on which processes and safeguards work best.” [Becker's]

A key component of the Readiness Rounds methodology is assuming something has failed until proven otherwise and celebrating the failures that are found. It’s much more valuable to find, fix and track failures or near misses prior to them resulting in an untoward event or being found by a regulatory agency during a survey. If staff members are performing rounds but are not in touch with the philosophy then you are hurting your organization's improvement efforts. Furthermore, the culture must instill that finding issues does not result in punitive action.

4. High reliability organizations defer to expertise. 

Leaders at high reliability organizations listen to people who have the most developed knowledge of the task at hand. Sometimes, those individuals might not have the most seniority, but they are still encouraged to voice their concerns, ideas and input — regardless of hierarchy. 

If leaders and supervisors don't listen to staff about processes and operations within the hospital, it is practically impossible for the organization to develop a culture of high reliability.” [Becker's]

A good example of Readiness Rounds methodology in action is the way in which it supports our clients with their infection prevention efforts. Our clients' infection prevention departments are conducting many different types of audits/surveys/rounds with our platformthe difference here, from the current model in healthcare, is that these IP specialists now have the data to back up any shortfalls in their hospital’s infection prevention programs. One would hope leadership is on board with this key concept of an HRO, but if there are some stragglers being exceptionally curmudgeonly, cold hard data can flip the narrative.

5. High reliability organizations are resilient. 

This trait could also be called relentlessness, says Mr. Studer. Leaders at high reliability organizations stay the course. They are prepared in how to respond to failures and continually find new solutions. They might improvise more, or quickly develop new ways to respond to unexpected events. High reliability organizations might experience numerous failures, but it is their resilience and swift problem solving that prevents catastrophes.” [Becker's]

We know that healthcare is slow to react to change and leadership is often in the business of fighting fires rather than installing smoke alarms. Sometimes that is a result of lack of ability to know where to focus effort. For example, you have a problem with falls, but what specifically is leading to it? The answers don’t appear to be in the EHR, but wouldn’t it be nice to not have to have another fall occur to learn from the costly event? Being able to see from observational quality data, that on 2-North & 5-South (where most of these have occurred) that the proper socks are only being utilized 44% of the time on patients assessed as high fall risks, can allow for quick decision making to drive PI initiatives.


While some of these traits are common sense, it's common to see most hospitals still struggling. That’s why we, at Readiness Rounds, are committed to helping bring the change needed to our clients with our high reliability methodology, performance improvement platform with guaranteed results to work towards a zero harm environment.

Readiness Rounds has spent the last ten years working one-on-one with clients, coaching them on our high reliability methodology. We have built an all-inclusive system that when implemented system-wide can and will improve a hospital's main performance outcomes, for such metrics as CMS and HCAHPS star levels, readmission rates, survey findings, and more. In fact, as your high reliability partner, we guarantee improvement. 

Take a look at the case study: White Plains Hospital Pioneers the Country's First High Reliability Approach

White Plains Hospital Case Study

Would you like to see how the high reliability model may help improve your outcomes? We offer free consultations to see how we can work together to achieve your goals. Book a free consultation now.

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