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Caveats for high reliability in healthcare

Caveats for high reliability in healthcare Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice.Design/methodology/approachClassic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care.FindingsHighly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care.Research limitations/implicationsDramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families.Practical implicationsAs healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities.Originality/valueThis paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Health Organisation and Management Emerald Publishing

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Publisher
Emerald Publishing
Copyright
© Emerald Publishing Limited
ISSN
1477-7266
DOI
10.1108/jhom-10-2017-0286
Publisher site
See Article on Publisher Site

Abstract

Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice.Design/methodology/approachClassic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care.FindingsHighly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care.Research limitations/implicationsDramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families.Practical implicationsAs healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities.Originality/valueThis paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends.

Journal

Journal of Health Organisation and ManagementEmerald Publishing

Published: Sep 3, 2018

Keywords: Safety; Quality; Healthcare; High-reliability organization (HRO); Increasing relative ignorance; Reliability seeking

References