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Towards high-reliability organising in healthcare: a strategy for building organisational capacity
  1. Hanan J Aboumatar1,2,
  2. Sallie J Weaver2,3,
  3. Dianne Rees3,
  4. Michael A Rosen2,3,
  5. Melinda D Sawyer2,4,
  6. Peter J Pronovost2,3
  1. 1Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  3. 3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4The Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Hanan J Aboumatar, Department of Medicine, Johns Hopkins University, North Caroline St., Suite 2080, Baltimore, Maryland 21287, USA; habouma1{at}


In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently employing at the Johns Hopkins Armstrong Institute for Patient Safety and Quality as part of an organisational strategy towards HRO. This framework considers organisation-wide competencies for SQ that includes all staff and faculty and is integrated into a broader organisation-wide operating management system for improving quality. In this framework, achieving safe, high-quality care is connected to healthcare workforce preparedness. Capacity-building efforts are tailored to the needs of distinct groups within the workforce that fall within three categories: (1) front-line providers and staff, (2) managers and local improvement personnel and (3) SQ leaders and experts. In this paper we describe this framework, our implementation efforts to date, challenges met and lessons learnt.

  • Medical education
  • Patient safety
  • Quality improvement

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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