Improving Patient Safety through High Reliability Organizations

By Tonya Morgan posted 10-27-2019 11:33 AM


Article Review:  Improving Patient Safety through High Reliability Organizations

            Improving Patient Safety through High Reliability Organizations is a case study analyzing an organization and how their practices can be improved by using the High Reliability Organizations (HRO) principles. It focuses on preventing medical errors in the nursing and respiratory staff specifically.  The HRO specific concepts of process standardization, checks and redundancy, authority migration, communication and teamwork were utilized in this process.

            There is a high cost associated with medical errors and humans are the source of most of these errors.  The cost is in physical dollars and emotions for the patient and staff member involved.  This article reported “Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society (Padget, Gossett, Mayer, Chien, and Turner, 2017).  According to a more recent article “A recent John Hopkins study claims more than 250,000 people in the US die every year from medical errors.  Other reports claim the number to be as high as 440,000 (Sipherd, 2018).  HRO strives to reduce these errors.  The eight most common causes of medical errors are:

  1. Communication problems – verbal or written
  2. Inadequate information flow – especially between facilities, service lines, test results or medication changes
  3. Human problems – knowledge base or not following policy or procedure
  4. Patient related issues – mis-identification, consent or patient education
  5. Organizational transfer of knowledge – lack of training or inadequate education
  6. Staffing patterns & workflows – inadequate staffing placing staff in situations they should not be in
  7. Technical failures – medical devices or computer issues
  8. Inadequate policies – failures in process of care can be traced to poor documentation and non-existent or inadequate procedures


            The case study collected data using non-management nursing and respiratory staff through interviews, direct observations and organization documentation reviews using the HRO theories.  


            The study participants spoke of common themes as part of their daily challenges regarding patient safety.  These include:

  • Policies (HRO principle)
  • Patient Care Improvements
  • Education and training (HRO principle)
  • Quality of life
  • Safety (HRO principle)
  • Communication (HRO principle)
  • Teamwork (HRO principle)
  • Staff Improvement
  • Risk Mitigation (HRO principle)

As the interviews, observation and reviewing took place, the study showed how the organization met HRO principles of process standardization, checks and redundancy, authority migration, communication and team work.  The results of this are below.

Process Standardization –

As new policies are implemented, the policies are posted visibly and reviewed in team meetings and monitored by management.

Checks and Redundancy –

Check list are developed for any given task ensuring critical information for the patient care is reported or communicated.  Forms for anonymous reporting of incidents or unsafe conditions.  Organizational policies are added to increase redundancy (such as second checks on medications, transfusions, patient lifting, etc…). When staff have to work together less errors occur.

Authority Migration –

Front line staff have the authority to make decisions when they have the knowledge/experience to do so.  This empowerment leads to ownership.  The organization included staff on the identification of risk and gives the staff the power to act and mitigate the risk (van Stralen et al, 2008).

Communication and Teamwork –

Communication is encouraged and requirements were built into polices.  Managers are approachable.  Team meetings “white board” communication concerning duties, policies and staff problems. Teamwork is affected by the redundancy in procedures, department integration, staff being aware of their roles and how it affects other staff members and patient safety. 

Current Industry Standards

            Reducing medical errors is at the forefront of health care organizations.  Implementing the increase use of computers (technology), increase additional patient safety training, focusing on hiring practices to ensure the most qualified individual is hired for the role has also affected the errors have all decreased medical errors.  Organizations have to continue to monitor and look to improve using the HRO principles to continue our battle of reducing medical errors.

Conclusion Applying HRO Principles

            HRO principles can be applied to any organization.  It is very strategic in nature and within my organization we are working to apply these principles.  The results of applying them has been better communication between team and patients, a better work climate, team members feel they have the authority to make decisions and ownership has increased.  We continue to work on training and standardization of processes.  For the patients and ourselves, we have to continue this transition daily to become a High Reliability Organization.




Bea, R., Roberts, K.  (2001). Must Accidents Happen? Lessons from High-Reliability Organizations. Retrieved from

Daniel, M. (2016). Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S.. Retrieved from

Padgett, J., Gossett, K., Mayer, R., Chien, W., & Turner, F. (2017). Improving Patient Safety through High Reliability Organizations. The Qualitative Report22(2), 410-425. Retrieved from

Sipherd, R. (2018). The third-leading cause of death in US most doctors don’t want you to know about. Retrieved from