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High reliability organizations
High reliability organizational change for hospitals: translating tenets for medical professionals
  1. M J Shapiro,
  2. G D Jay
  1. Center for Safety in Emergency Care, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA
  1. Correspondence to:
 Dr M J Shapiro, Center for Safety in Emergency Care, Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA; 

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Health care will continue to struggle to improve patient safety until the medical industry and hospital leaders understand that the tenets of high reliability organizations can be translated for physicians and nurses.

Despite the significantly increased attention to patient safety, it remains unclear what role healthcare professionals—both individually and collectively—should play in supporting organizational change. Concurrently, the model of error is shifting away from the individual towards the system to search for solutions, which has left a void in the area of human performance. Medical industry leaders at the chief executive level have a vision which focuses on information systems and streamlined system improvements. These tangible technological solutions, such as Computerized Physician Order Entry (CPOE), share specificity to fix an identifiable problem, making them comfortable targets for patient safety initiatives. While this approach will yield positive results, it is important to remember that up to 75% of information technology solutions are likely to fail.1 Complementary behavioral solutions such as teamwork should therefore be recognized for their potential to mitigate error and increase system resilience.2,3 These human performance interventions, because of their broad adaptability, may have the potential to produce a greater reduction in adverse events. Reluctance to adopt lessons learned in other industries, some of them in the form of qualitative data, is partly what fuels the controversy between the evidence-based camps and healthcare safety experts who feel there is an urgency to act.4,5 For example, the Institute of Medicine (IOM) recommendation 8.1 to adopt crew resource management (CRM) and proven training methods (simulation) and to train teams in the units where they actually function (IOM …

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