No harm in learning – A balanced High Reliability Organisation (HRO) approach in healthcare

Darren Van Laar, Caroline Strevens, Ashraf Labib, Caroline Mitchell*

*Corresponding author for this work

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This multi-site study measures different aspects of patient safety culture within selected secondary and tertiary care NHS hospitals by applying High Reliability Organisations (HRO) principles. We propose a new balanced definition of HRO within health setting with a new maturity grid, and use an instrument to survey various staff across hospitals. An electronic online questionnaire surveyed all staff grades across three NHS hospital trusts. The sample consisted of 1,243 randomly selected staff. We used a high reliability organisation (HRO) framework consisting of five dimensions to estimate maturity levels linked to patient safety culture to create a measurable and replicable process for benchmarking and improvement. The proposed maturity grid provides a clear and concise road map to support senior managers in formulating a patient safety strategy based on a higher level in maturity with respect to HRO five principles. The proposed methodology can also predict the likely direction of improvement, or deterioration, if no action is taken with respect to each of the HRO principles. Although healthcare leaders consider the principles of high reliability organisations (HROs) as a guide for strategy to improve patient safety, there is evidence that these principles are underused in the measurement and subsequent analysis of their impact on patient safety culture. Our approach provides a structured methodology that aims to contribute to streamlining implementation and monitoring of HRO principles towards improving safety and resilience.
Original languageEnglish
Pages (from-to)1-19
Number of pages19
JournalJournal of Social and Economic Statistics
Issue number2
Publication statusPublished - 1 Dec 2023


  • High Reliability Organisations
  • Patient Safety Culture
  • Organisational Maturity

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