Design of High Reliability Organizations in Health Care

Qual Saf Health Care. 2006 Dec;15 Suppl 1(Suppl 1):i4-9. doi: 10.1136/qshc.2005.015867.


To improve safety performance, many healthcare organizations have sought to emulate high reliability organizations from industries such as nuclear power, chemical processing, and military operations. We outline high reliability design principles for healthcare organizations including both the formal structures and the informal practices that complement those structures. A stage model of organizational structures and practices, moving from local autonomy to formal controls to open inquiry to deep self-understanding, is used to illustrate typical challenges and design possibilities at each stage. We suggest how organizations can use the concepts and examples presented to increase their capacity to self-design for safety and reliability.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Delivery of Health Care / organization & administration*
  • Efficiency, Organizational
  • Humans
  • Models, Organizational
  • Organizational Innovation
  • Quality of Health Care / organization & administration*
  • Reproducibility of Results
  • Safety Management / organization & administration
  • United States