The Five Principles of High Reliability Organizations in Health Care


What do naval aircraft carriers, nuclear power plants, and the health care system have in common?

What do naval aircraft carriers, nuclear power plants, and the health care system have in common? They all aspire to be high reliability organizations. High reliability organizations operate under high-stakes conditions but produce minimal error. Drs. Karl E Weick and Kathleen M. Sutcliffe describe 5 principles of high reliability organizations in their book “Managing the Unexpected: Resilient Performance in an Age of Uncertainty." These principles can apply to any organization. Below are the 5 principles and how they relate to good practice in health care.

Preoccupation with Failure

Don’t develop crippling anxiety that interferes with your ability to work, but realize the importance of your position. Repetitive tasks including data entry may sometimes feel mundane, but attention and good judgment is crucial to providing the best care for our patients. Absent-mindedness could lead to the death of a patient.

Reluctance to Simplify

Don’t jump to conclusions. Understand the complexity of your organization and of patient’s unique histories. Conduct logic-based root cause analyses to analyze events and don’t let your opinion get in the way. Don’t allow yourself to get bogged down by complexity, but be careful to avoid mental traps like overgeneralization.

Sensitivity to Operations

Make your best effort to understand the reasoning behind policies and protocols. Consider how procedures are affecting outcomes on a larger scale. Understanding standard practice can also allow you to become more aware of areas that could be improved.

Commitment to Resilience


Push through setbacks. Try to consider mistakes as opportunities for improvement. A commitment to resilience implies this must be a conscious act of will, not an inherent trait. Actively strive to overcome negativity and don’t give up when life doesn’t go your way.

Deference to Expertise

Be aware of your own strengths and weaknesses. Respect the practice and educational background of other healthcare professionals. Contribute evidence-based ideas on best practice with confidence, but be honest with yourself and others if you encounter an issue you can’t immediately solve. It is better to be honest than provide an incorrect guess. If everyone on a team is able to play to their strengths, it will be a recipe for success.



Weick, Karl E.; Kathleen M. Sutcliffe (2001).Managing the Unexpected-Assuring High Performance in an Age of Complexity.San Francisco, CA, USA: Jossey-Bass

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