Direct reliability: strategies to revolutionize healthcare

  • Julie Babyar



The aim of this article is to understand the current climate of high reliability in healthcare and explore comprehensive approaches to measure future healthcare transformation.

Subjects and methods

Literature pertaining to high reliability in industry and healthcare organizations was reviewed, with a focus on publications from 2006–present.


Readiness assessments, components, frameworks and comparisons to external industries have been produced in the literature and discussed within healthcare expertise. High reliability in healthcare organizations remains opaque, with varied structures to recommendations, despite continued interest and accreditation focus. Advancing high-reliability science for healthcare has remained elusive.


Strategies to revolutionize healthcare utilizing reliability should be considered imperative opportunities. These strategies include conceptualizing high-reliability science for healthcare as holistic, incorporating recommended robust process improvements along all spectra of healthcare, standardizing criteria to constitute a high-reliability organization in healthcare and measuring high reliability qualitatively, with the understanding that avoided catastrophic failures should be factored, and emphasizing public trust in medicine as a priority for high reliability. Notably, patient satisfaction and patient perception of reliable healthcare must be included at the forefront. By harnessing these strategies, healthcare will move reliability from an indirect cultural philosophy to the direct, revolutionary spotlight. A spotlight on reliability is positive, commendable and important to honor.


High reliability Reliability science High-reliability organizations Customer satisfaction Patient satisfaction 



Agency for Healthcare Research and Quality


Complex adaptive system


Evidence-based practice


High-reliability organization


High-reliability theory


Normal accident theory


Robust process improvements


Authors’ contributions

The author is the sole author of this manuscript.


There are no funding contributions to declare.

Compliance with ethical standards

Consent for publication

The author consents to publication of this article.

Competing interests

There are no competing interests to declare.


  1. Baker DP, Day R, Salas E (2006) Teamwork as an essential component of high-reliability organizations. Health Serv Res 41:1576–1598CrossRefGoogle Scholar
  2. Batterham AM, George KP (2000) Reliability in evidence-based clinical practice: a primer for allied health professionals. Phys Ther Sport 1:54–62CrossRefGoogle Scholar
  3. Brown DS, Donaldson N, Burnes Bolton L, Aydin CE (2010) Nursing-sensitive benchmarks for hospitals to gauge high-reliability performance. J Healthc Qual 32:9–17CrossRefGoogle Scholar
  4. Carroll JS, Rudolph JW (2006) Design of high reliability organizations in health care. Qual Saf Health Care 15(Suppl 1):i4–i9CrossRefGoogle Scholar
  5. Chassin MR, Loeb JM (2011) The ongoing quality improvement journey: next stop, high reliability. Health Aff 30:559–568CrossRefGoogle Scholar
  6. Chassin MR, Loeb JM (2013) High-reliability health care: getting there from here. Milbank Q 91:459–490CrossRefGoogle Scholar
  7. Christianson MK, Sutcliffe KM, Miller MA, Iwashyna TJ (2011) Becoming a high reliability organization. Crit Care 15:314CrossRefGoogle Scholar
  8. Dixon NM, Shofer M (2006) Struggling to invent high-reliability organizations in health care settings: insights from the field. Health Serv Res 41:1618–1632CrossRefGoogle Scholar
  9. Frankel AS, Leonard MW, Denham CR (2006) Fair and just culture, team behavior, and leadership engagement: the tools to achieve high reliability. Health Serv Res 41:1690–1709CrossRefGoogle Scholar
  10. Gnanapragasam A, Cole C, Singh J, Cooper T (2018) Consumer perspectives on longevity and reliability: a national study of purchasing factors across eighteen product categories. Procedia CIRP 69:910–915CrossRefGoogle Scholar
  11. Hall MA, Dugan E, Zheng B, Mishra AK (2001) Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 79:613–639CrossRefGoogle Scholar
  12. Knox GE, Simpson KR (2011) Perinatal high reliability. Am J Obstet Gynecol 204:373–377CrossRefGoogle Scholar
  13. Lachin JM (2004) The role of measurement reliability in clinical trials. Clin Trials 1:553–566CrossRefGoogle Scholar
  14. Martinez GF, Ross E, Knox KS (2017) Academic medicine: vice chairs’ for education perceptions of departmental culture. Journal of Higher Education Theory and Practice 17:81Google Scholar
  15. McKeon LM, Oswaks JD, Cunningham PD (2006) Safeguarding patients: complexity science, high reliability organizations, and implications for team training in healthcare. Clin Nurse Spec 20:298CrossRefGoogle Scholar
  16. McKeon LM, Cunningham PD, Oswaks JSD (2009) Improving patient safety: patient-focused, high-reliability team training. J Nurs Care Qual 24:76–82CrossRefGoogle Scholar
  17. Melnyk BM (2012) Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice. Nurs Adm Q 36:127–135CrossRefGoogle Scholar
  18. Philibert I (2009) Use of strategies from high-reliability organisations to the patient hand-off by resident physicians: practical implications. Qual Saf Health Care 18:261–266CrossRefGoogle Scholar
  19. Pronovost PJ, Berenholtz SM, Goeschel CA, Needham DM, Sexton JB, Thompson DA, Lubomski LH, Marsteller JA, Makary MA, Hunt E (2006) Creating high reliability in health care organizations. Health Serv Res 41:1599–1617CrossRefGoogle Scholar
  20. Pronovost PJ, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, National Leadership Core Measures Work Groups (2013) Demonstrating high reliability on accountability measures at the Johns Hopkins Hospital. Jt Comm J Qual Patient Saf 39:531–544CrossRefGoogle Scholar
  21. Pronovost PJ, Armstrong CM, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Yang T, Peterson RR, Reitz JA, Bennett RG, Broccolino VA, Davis RO, Gragnolati BA, Green GE, Rothman PB (2015) Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins medicine. Acad Med 90:165–172CrossRefGoogle Scholar
  22. Provost SM, Lanham HJ, Leykum LK, McDaniel RR Jr, Pugh J (2015) Health care huddles: managing complexity to achieve high reliability. Health Care Manag Rev 40:2–12CrossRefGoogle Scholar
  23. Prybil L, Scutchfield FD, Killian R, Kelly A, Mays GP, Carman A, Levey S, McGeorge A, Fardo DW (2014) Improving community health through hospital-public health collaboration: Insights and lessons learned from successful partnershipsGoogle Scholar
  24. Riley W, Davis SE, Miller KK, Mccullough M (2010) A model for developing high-reliability teams. J Nurs Manag 18:556–563CrossRefGoogle Scholar
  25. Roberts KH, Robert Bea, Dean L. Bartles (2001) Must accidents happen? Lessons from high-reliability organizations [and executive commentary]. The Academy of Management Executive (1993–2005) 15:70–79Google Scholar
  26. Shortell SM, Zukoski AP, Alexander JA, Bazzoli GJ, Conrad DA, Hasnain-Wynia R, Sofaer S, Chan BY, Casey E, Margolin FS (2002) Evaluating partnerships for community health improvement: tracking the footprints. J Health Polit Policy Law 27:49–91CrossRefGoogle Scholar
  27. Sutcliffe KM, Paine L, Pronovost PJ (2017) Re-examining high reliability: actively organising for safety. BMJ Qual Saf 26:248–251CrossRefGoogle Scholar
  28. Tamuz M, Harrison MI (2006) Improving patient safety in hospitals: contributions of high-reliability theory and normal accident theory. Health Serv Res 41:1654–1676CrossRefGoogle Scholar
  29. Thomassen Ø, Espeland A, Søfteland E, Lossius HM, Heltne JK, Brattebø G (2011) Implementation of checklists in health care; learning from high-reliability organisations. Scand J Trauma Resusc Emerg Med 19(53)Google Scholar
  30. Wilson KA, Burke CS, Priest HA, Salas E (2005) Promoting health care safety through training high reliability teams. Qual Saf Health Care 14:303–309CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.VallejoUSA

Personalised recommendations