Academic and professional disciplines, such as organisation and management theory, psychology, sociology and engineering, have, for years, grappled with the multidisciplinary issues of safety and accident prevention. However, these ideas are just beginning to enrich research on safety in medicine. This article examines a domain of research on system safety - the High Reliability Organization (HRO) paradigm. HROs operate in hazardous conditions, but have fewer than their fair share of adverse events. HROs are committed to safety at the highest level and adopt a special approach to its pursuit. The attributes and operating dynamics of the best HROs provide a template on which to better understand how safe and reliable performance can be achieved under trying conditions, and this may be useful to researchers and caregivers who seek to improve safety and reliability in health care.
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