Flight Decks and Isolettes: High-Reliability Organizing (HRO) as Pragmatic Leadership Principles during Pandemic COVID-19

The COVID-19 crisis has created a physical environment where neonatologists and neonatal staff face exposure to an easily transmissible, potentially fatal infection in the course of their duties. Leaders cannot reject an assignment, such as a resuscitation of a newborn, because of risk. As in military operations, safety and capability cannot be separated from neonatal operations. Leadership models developed in stable environments do not fully translate to dynamic, uncertain situations where the leader and subordinates personally face threats; the type of environment from which the High-Reliability Organization (HRO) emerged. There must be a shift from the increasingly abstract, academic, and normative representation of HRO leadership to its original, more pragmatic frame that iteratively supports engagement. The purpose of this paper is to present HRO as leadership principles, bridging the gap between abstract theory and practice by bringing attention to HRO as a scientifically supported pragmatic leadership stance.