Improving long-term care services: insights from high-reliability organizations

Purpose Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs). Design/methodology/approach The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches. Findings To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience. Originality/value This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.

Establishment of Elements and Principles of High Reliability Organizations in Neonatal Intensive Care Unit of de Soyza Maternity Hospital, Colombo, Sri Lanka.

Introduction: “High Reliability Organizations (HRO)” is an innovative safety management concept. An effort to transform a health care setting in Sri Lanka to a HRO – management structure is worthwhile to experience the outcomes of this model in Sri Lankan hospital context. Objective: To establish a HRO - management structure in the Neonatal Intensive Care Unit of De Soyza Maternity Hospital Colombo. Design: Pre / post interventional study design was used. Functional status of HRO structure in the NICU was assessed; using 5 HRO principles (ie. Pre occupation with failure, Resistance to simplify, Sensitivity to operations, Commitment to resilience and Deference to expertise) and 5 HRO elements (ie. Process auditing, Rewarding, Avoidance of quality degradation, Risk perception, and Command and control), at pre and post interventional levels. Methods: Practice of HRO principles was assessed using a Self - Administered Questionnaire with a rating scale, with the participation of all the NICU staff. Practice of HRO elements was assessed by a facility survey using a check list. Intervention consisted of a managerial plan with activities to establish the HRO concept. Results: Results showed a statistically significant increase of “response scores” of participants towards HRO structure and the facility survey showed the establishment of planned activities. Conclusion: It was concluded that implementation of this plan, is gradually establishing the HRO management structure in NICU of DMH.

Maintaining Resilience in Times of Crisis: Insights From High-Reliability Organizations

In the tumultuous and unprecedented times of the 21st century, resilience is more important than ever for organizational success. High-reliability organizations (HROs) are known for their ability to operate effectively in high-risk contexts by preventing avoidable crises and maintaining resilience when challenges arise. In the psychology literature, resilience is the phenomenon of overcoming adversity with minimal negative impact to performance and well-being. Although the study of psychological resilience began at the individual level, researchers are beginning to adopt a multilevel perspective of the construct that accounts for resilience at the team and organizational levels. While the science of HROs has been studied for several decades, research on psychological resilience in the workplace has only just begun to flourish by comparison. There are many lessons for creating and maintaining resilience that can be learned from the successful practice of HROs. HROs have systems of layered defenses in place that allow the organization to prevent precluded events and overcome the potential negative impact of adverse conditions and near misses. Organizations that conduct work in high-risk contexts may be able to model the success of HROs by keeping learning foremost, investing time and resources into team training, supporting a climate of psychological safety, coaching employees to keep performance objectives in focus, and practicing systems thinking and accounting for complexity in resource allocation. Maintaining resilience is not a duty outlined in a formal job description, yet it is undoubtedly important for enabling effective high-risk work. Going above and beyond the formal definition of roles may be the only route to effectiveness in these organizations.

Shaping the Safety Culture of High Reliability Organizations through Digital Transformation

The aim of the article is to present key mechanisms for shaping the safety culture of high reliability organizations through digital transformation, which is now a key challenge for the entire global economy. It is particularly important in processes conducted by so-called high reliability organizations. From this cognitive perspective, it is important to define the place and role of digital transformation in shaping the safety culture of high reliability organizations. The comparison of the issues of the safety culture and digital transformation of high reliability organizations seems to be an important cognitive aspect resulting from technological progress in the area of the digital economy. The socio-technological system in which high reliability organizations exist is organized in such a way that all technical, operational and organizational aspects, including the participation of many entities involved in the operation of this complex system, are coherent. This coherence can be influenced by the digital transformation solutions that are implemented and used. The article used the analytic hierarchy process (AHP) and Vester methods, which were used for research by railway undertakings operating on the Polish railway market, to solve the scientific problem. A ranking of specific issues responsible for building safety culture and the identification of factors that are important for the effectiveness of the process of shaping the expected safety culture was created.

Space and sensemaking in high-reliability task contexts: Insights from a maritime mass rescue exercise

The spatial environment shapes sensemaking in complex situations. While we know that actors in high-reliability task contexts often have a certain degree of control over their spatial environment, it remains unclear how they enact their spatial environment and which effect this has on their sensemaking. In this paper, we use micro-ethnographic video data from two maritime mass rescue exercises to fill this gap. We find that actors that are under a high cognitive load enact space incidentally and fail to re-enact their spatial environment when problems arise. Instead, actors engage in micro-activities that temporarily mitigate the problems created by their space enactment. We develop a model on space and sensemaking in high-reliability task contexts that distinguishes between unenacted, enacted and lived space. Our findings point towards nested sensemaking, where the enacted spatial environment becomes part of the overall ‘story’ of an operation. Our findings have implications for our understanding of space and sensemaking in high-reliability task contexts, provide opportunities to improve high-reliability organizations’ performance and add to research on space and organising.