High-reliability organizations (HROs) operate in complex, high-hazard domains for extended periods
without serious accidents or catastrophic failures1. They prioritize safety over other performance
pressures1.
The principles of high reliability go beyond standardization; high reliability is better described as a
condition of persistent mindfulness within an organization1. HROs work to create an environment in
which potential problems are anticipated, detected early, and virtually always responded to early
enough to prevent catastrophic consequences1.
One of the key characteristics of HROs is a preoccupation with failure1. Everyone is aware of and
thinking about the potential for failure1. Near misses are viewed as opportunities to learn about
systems issues and potential improvements, rather than as evidence of safety1.
Another important characteristic is deference to frontline expertise1. This means that those closest
to the work, who have the most direct knowledge of the situation at hand, have the authority to
make decisions1.
In the given scenario, meeting with the staff involved in the errors to gain additional insight (Option
B) aligns with these principles. It shows a preoccupation with failure and deference to frontline
expertise. By meeting with the staff, leadership can understand what led to the errors and how to
prevent them in the future. This approach is consistent with the principles of high reliability and is
likely to contribute to the clinic’s goal of becoming a high-reliability organization.
