High-Reliability Organizing (HRO) in the COVID-19 Liminal Zone: Characteristics of Workers and Local Leaders

Stralen, van; Daved,; Thomas, Ann

doi:10.51362/neonatology.today/2021416490101

Cited by 11 publications

(11 citation statements)

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“…High-Reliability Organizing, an activity (the "verb" to organize for high reliability), engages the indeterminate, ambiguous, or illstructured problem embedded in the environment, addresses the abrupt, exigent circumstance, and responds to catastrophic failure (23,(30)(31)(32). We describe this as the VUCA-2T environment (Volatility, Uncertainty, Complexity, Ambiguity-Threat, and Time Compression, see Table 1) (24), modified from the US Army concept VUCA (33,34) and the anthropologic concept of liminality (35). Such situations do not often readily translate into straightforward problems with definitive constituents, rules, and outcomes (7,23,25).…”

Section: "Much Of the Academic Criticism Of Common Sense Is Directed At These Categorizations Of Common Sense The Visibility Of Practicalmentioning

confidence: 99%

Common Sense High Reliability Organizing (HRO) in the Response to COVID-19

Stralen

Daved

Thomas³

2021

Neonatology Today

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We find descriptions of common sense in the domains of anthropology, artificial intelligence, and psychiatry. This is the common sense for adaptation, a form of practical intelligence that better predicts success in everyday experiences, if not real-world survival. This common sense is experienced-based knowledge rather than rule-based. When unexpected situations occur, it supports continuous assessments and decisions to adjust to the conditions at hand. Overwhelmingly practical, common-sense deals with a concrete situation on its own terms. Common sense describes cultural knowledge and behaviors. Inquiry drives practical common sense.

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Section: "Much Of the Academic Criticism Of Common Sense Is Directed At These Categorizations Of Common Sense The Visibility Of Practicalmentioning

confidence: 99%

Common Sense High Reliability Organizing (HRO) in the Response to COVID-19

Stralen

Daved

Thomas³

2021

Neonatology Today

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“…The environment of VUCA-2T Elsewhere we have described the environment of practice (20), that is, the experienced environment we have in common with military operations, public safety, neonatology, critical care, medisocial work, and pediatric subacute care. We have worked closely with all these programs with a robust human behavior component in both internal and external environments, a distinguishing feature from socio-technical systems.…”

Section: Daved Van Stralen 1973mentioning

confidence: 99%

“…They remain unstudied and under-described except for and spectators. For operators, the acceptance of uncertainty and fear is unique (20), capability calibrates the threat response (3), and operators focus on possibility over probability. The more sig-ness to say, "I don't know."…”

Section: Mental Responsesmentioning

confidence: 99%

“…During the more deliberate extension of a discipline, we can identify and correct inductive errors not acting and engaging or not engaging can be equally harmful. In uncertain situations where a consequence includes death, inductive reasoning to identify 'probably correct' conclusions engenders vulnerability, which paradoxically increases safety (20). On the other hand, deductive reasoning seems a better approach as the conclusion is guaranteed to be true.…”

Section: Induction and Deductionmentioning

confidence: 99%

“…We can infer information in these situations. For that, we must ceptance and control of the feeling of fear (20), neuromodulation of stress-fear-threat (3), and social organizing to prevent the ecology of fear (11). Behaviors come in suites coordinated for various purposes (28,29).…”

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High-Reliability Organizing (HRO) and Abrupt Change from COVID 19: Failure of Scientific Rationality and Classical Logic

Stralen

2021

Neonatology Today

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Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre–Post Quasi-Experimental Quality Improvement Project

Sawyer,

Thiyarajan,

Essen

et al. 2024

Military Medicine

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Introduction The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework. Materials and Methods This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre–post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites. Results There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2—Risk Identification and Just Culture—and Dimension 4—Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2. Conclusions The results of this QI project will inform further refinements to VHA’s efforts to implement HRO principles and practices in the nation’s largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

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High-Reliability Organizing (HRO) in the COVID-19 Liminal Zone: Characteristics of Workers and Local Leaders

Cited by 11 publications

References 37 publications

Common Sense High Reliability Organizing (HRO) in the Response to COVID-19

Common Sense High Reliability Organizing (HRO) in the Response to COVID-19

High-Reliability Organizing (HRO) and Abrupt Change from COVID 19: Failure of Scientific Rationality and Classical Logic

Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre–Post Quasi-Experimental Quality Improvement Project

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