TY - JOUR T1 - High reliability organising in healthcare: still a long way left to go JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-014141 SP - bmjqs-2021-014141 AU - Christopher G Myers AU - Kathleen M Sutcliffe Y1 - 2022/06/14 UR - http://qualitysafety.bmj.com/content/early/2022/06/14/bmjqs-2021-014141.abstract N2 - Over 20 years ago, in its enduringly impactful report To Err is Human, the US Institute of Medicine (IOM) claimed that healthcare is not unique among high-risk, high-reliability industries, pointing out that it too is concerned with learning how to prevent, detect, recover and learn from mistakes and accidents.1 That observation was based on research conducted by an interdisciplinary group at the University of California at Berkeley who were ‘curious about the seemingly theory-defying ability of some organizations to avoid catastrophic operational outcomes despite operating technologies that were fraught with exceptionally high levels of risk, uncertainty, hazard, and public intolerance of failures’.2 Although functionally different, these ‘high reliability organizations’ (HROs) achieved exceptionally high and sustained levels of performance as a consequence of deliberate, ongoing, organisational efforts characterised by the five principles of: preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience and deference to expertise.3 HROs are adaptive organisational forms for complex environments; the ways in which they organise are considered to be a ‘dormant infrastructure for performance improvement in all types of organizations’.4 HRO-related research has proliferated in the last two decades and has had remarkable impact on research, policy and practice across multiple industries—especially healthcare.2Interventions to improve healthcare quality and safety grounded on HRO theory have become commonplace, with professional governing bodies such as The Joint Commission, the accreditation agency for hospitals in the USA, going so far as to propose that all healthcare institutions adopt HRO principles.5 Yet, little is known about how these interventions have fared, with a particular dearth in understanding the mechanisms of change that might explain more or less successful adoption. Organisational research on change in healthcare is more often focused on what has changed, rather than on how or why, … ER -