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Healthcare organizations can learn a lot about how to handle complexity from High Reliability Organizations (HROs).  Healthcare consumers should demand that the organizations that serve them follow the modus operandi of HROs.

HROs operate according to 5 basic principles:

1. track small failures by listening for early signals of failures.  2. resist oversimplification. 3. remain sensitive and focused on operations. 4. maintain capabilities for resilience. 5. take advantage of expertise located anywhere in the organization.

This is the work of Karl Weick and Kathleen Sutcliffe.  They have studied HROs ranging from fire fighters, to aircraft carriers to nuclear power plants. It is clear that if there was a failure in these types of organizations that it would be catastrophic.

So these types of HRO organizations operate according to the 5 basic principles described by Karl Weick and Kathleen Sutcliffe.

Let’s dig into each of the 5 principles:

1. track small failures by listening for early signals of failures .

HROs are different because they are obsessed with failure. They treat every lapse as an indication that something may be wrong. It is in their DNA. They are wary of complacency and drifting into automatic processing. Small failures can signal larger failures. They are mindful and act when they sense any signs of failure.

2.resist oversimplification.

HROs recognize that the environment that they operate in is complex, unknowable and unpredictable. They welcome diverse opinions and experience, are skeptical of conventional wisdom and respect the nuances that diverse people express. Facing a complex environment using mental models that simplify to make life easier is the recipe for a disaster. HROs recognize that lazy thinking can lead to failures.

3.remain sensitive and focused on operations.

HROs focus on making continuous adjustments to operations because of acute situational awareness. When situational awareness is fine tuned, small errors remain small errors. Without this awareness and without the ability to fine tune operations, small errors can become a perfect storm- system failure.

4.maintain capabilities for resilience.

The essence of resilience is the ability of an organization to continue operating when it has confronted a major mishap or accident or error. According to Wieck, an HRO that is operating well is not error-free but errors do not disable it.

5. take advantage of expertise located anywhere in the organization.

Well managed HROs want diversity because diversity helps them cope in complex environments.  HROs do not rely on the expert but source expertise wherever it is in the organization. That implies that organizational hierarchy (who is on top) does not prevent information from rising up in the organization from the front line where expertise exist.


Health care consumers have a right to demand that the health care organizations that serve them use the 5 principles that HROs employ.

Healthcare organizations should be preoccupied with failure. They should not oversimplify.  They should continuously monitor and adjust operations. They should commit to being resilient organizations that can keep on ticking when hit by a missile or two. They should value expertise wherever it is located in the organization.

If healthcare consumers know about these 5 principles and start the conversation with the leaders of their local healthcare organizations, then many medical mistakes will be avoided and lives saved.  The benefits will be enormous.