PT  - JOURNAL ARTICLE
AU  - K H Roberts
AU  - P Madsen
AU  - V Desai
AU  - D Van Stralen
TI  - A case of the birth and death of a high reliability healthcare organisation
AID  - 10.1136/qshc.2003.009589
DP  - 2005 Jun 01
TA  - Quality and Safety in Health Care
PG  - 216--220
VI  - 14
IP  - 3
4099  - http://qualitysafety.bmj.com/content/14/3/216.short
4100  - http://qualitysafety.bmj.com/content/14/3/216.full
SO  - Qual Saf Health Care2005 Jun 01; 14
AB  - High reliability organisations (HROs) are those in which errors rarely occur. To accomplish this they conduct relatively error free operations over long periods of time and make consistently good decisions resulting in high quality and reliability. Some organisational processes that characterise HROs are process auditing, implementing appropriate reward systems, avoiding quality degradation, appropriately perceiving that risk exists and developing strategies to deal with it, and command and control. Command and control processes include migrating decision making, redundancy in people or hardware, developing situational awareness, formal rules and procedures, and training. These processes must be tailored to the specific organisation implementing them. These processes were applied to a paediatric intensive care unit (PICU) where care was derived from problem solving methodology rather than protocol. After a leadership change, the unit returned to the hierarchical medical model of care. Important outcome variables such as infant mortality, patient return to the PICU after discharge, days on the PICU, air transports, degraded. Implications for clinical practice include providing caregivers with sufficient flexibility to meet changing situations, encouraging teamwork, and avoiding shaming, naming, and blaming.