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Design of high reliability organizations in health care
  1. J S Carroll1,
  2. J W Rudolph2
  1. 1MIT Sloan School of Management, Cambridge, MA, USA
  2. 2VA Boston Healthcare System and Boston University School of Public Health, Boston, MA, USA
  1. Correspondence to:
 Professor J S Carroll
 MIT Sloan School of Management, 50 Memorial Drive, Cambridge, MA 02142, USA; jcarroll{at}


To improve safety performance, many healthcare organizations have sought to emulate high reliability organizations from industries such as nuclear power, chemical processing, and military operations.We outline high reliability design principles for healthcare organizations including both the formal structures and the informal practices that complement those structures. A stage model of organizational structures and practices, moving from local autonomy to formal controls to open inquiry to deep self-understanding, is used to illustrate typical challenges and design possibilities at each stage. We suggest how organizations can use the concepts and examples presented to increase their capacity to self-design for safety and reliability.

  • high reliability organization
  • design
  • patient safety

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  • JWR’s work on this article was supported by a Merit Review Entry Program career development grant from the US Department of Veterans Affairs.

  • Competing interests: none declared.