Recently I attended the New England Healthcare Engineering Society annual fall conference. The multi-day event, held in New Hampshire’s White Mountains, was managed by members of the New Hampshire Healthcare Engineers Society and my colleagues at Gosselin Associates, Michele Deane and Jack Gosselin. 

Over the past year I have spoken with many facility directors who say their organization is in the process of becoming a High Reliability Organization (HRO), so I attended a session presented by Dartmouth-Hitchcock Medical Center about the topic. 

HROs are “organizations that have succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.” The theory of high reliability originated with naval aviation and the nuclear power industry and was developed by researchers at the University of California Berkeley. Healthcare, with its demands of 24X7X365 reliability and patient safety, is well suited for an HRO approach. The key characteristics of an HRO are:  

  1. Preoccupation with Failure
  2. Reluctance to Simplify Interpretations
  3. Sensitivity to Operations (an HRO Distinguishing Characteristic)
  4. Commitment to Resilience
  5. Deference to Expertise

Communication & engagement key

As I sat and listened to the HRO presentation, my mind wandered to the importance of employee communication and engagement prior to HRO rollout and implementation. 

For an HRO process, or any process, to succeed, honest communication and employee interaction must be a fabric of the organization and practiced daily. More than writing familiar words like compassion, respect, dignity, and accountability on glossy posters that adorn cafeterias and elevator lobbies, organizations must live these words. Employees see through processes that aim for improvement, but don’t reflect the reality of the work environment.

Whether true or not, popular culture tells us Teddy Roosevelt once uttered “People don’t care how much you know until they know how much you care.” 

How accurate! So whether the process is HRO, Six Sigma, Lean or Green, true success lies with engaged employees. It’s easy to lose the employee focus in the process focus, but organizational values must be practiced for process to succeed. TR’s famous bully pulpit may have worked to influence people in the early 1900s, but in 2016 it is likely to fail over the long-term. 


Healthcare organizations can utilize The Joint Commission’s organizational assessment tool, Oro 2.0 High Reliability Organizational Assessment. For more information please see

Best regards,                                                                                                                                         

Peter Martin                                                                                                                                                                                                                         

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