High-reliability organizations create the safest and most effective operations and then constantly re-assess for any possibility of failure before an incident occurs, including near-miss events. High-reliability principles are: Preoccupation with failure, reluctance to simplify, sensitivity to operations, deference to expertise and commitment to resilience.
These often come across as abstract concepts. How is preoccupation with failure displayed? How is sensitivity to operations shown? If an organization has hardwired chains of command, how do these teams defer to expertise when that expert is not the ranking person on the scene? (Christianson, Sutcliff et al., 2011). How does high-reliability become operationalized?
Operationalization
One solution: the timeline of an incident can be consulted (Worden & Lombardo, 2016). Proactive measures such as hazard analyses, information programs and leading indicators fall to the left to the incident, what Riley and Van Horne of the United States Marine Corps referred to as keeping all actions to the “left of bang” (Riley & Van Horne, 2014). Actions to the right of the incident are reactive to the incident. Operational activities for each element of the incident timeline transform high-reliability from abstract to a pragmatic, actionable practice.
Hazard analysis
Hazard analyses must be completed through brainstorming and reactively identifying failures already known. This must cover possible hazards and threats and who in the organization is vulnerable to them. These can also be assessed by the frequency of previous occurrences and possible severity of consequence should they reoccur. This helps identify which hazards/threats are more likely to manifest so that resources can be allocated quickly when budget, manpower and other constraints are present.
The organization has now created a means to be preoccupied with failure. By gathering information on processes, equipment and other factors in the workplace from the knowledgeable, deference to expertise is also now exemplified in an actionable process.
Hazard controls and information programs
After hazards are analyzed, hazard controls are implemented to prevent incidents, starting with elimination and moving onto substitution, engineering, administration and personal protective equipment. Training must be provided to ensure all affected employees know how to use the control.
With hazard controls now in place and employees trained, an information program – everything from bulletin boards to safety huddles to emails to meetings to training sessions and the like – provides consistent, recurring reinforcement of the hazard control expectation. Through these hazard controls and their communication, the organization has now created a means to continue deferring to experts on each process to create the most effective hazard control while also beginning to engage in reluctance to simplify. Often, organizations will assume that employees have been trained on a process and that this will enable safe operations when, in fact, the most effective hazard control has not been implemented so the safest possible operations are not possible. The organization has tried to simplify the process when it should not have.
Leading and lagging indicators
With safe processes implemented, the potential incident on the incident timeline falls between leading and lagging indicators. Leading indicators validate whether or not the safe processes and hazard controls are being used and whether they are operationally effective and as safe as possible. For example, if the determined hazard control for a table saw is to use the machine guard over the point of operation/saw blade, a leading indicator could be an observation to monitor whether or not the guard is being used and also whether or not the guard is providing safety as intended.
Lagging indicators measure how many times the safe work practices were not followed and how bad the consequences were. For example, should the above machine guard not be used and incidents occur, lagging indicators could be the number of incidents from the same cause, the cause(s) themselves – such as lack of equipment or human error – and financial losses.
Know this: a leading indicator provides critical data that can be used to prevent injuries; lagging indicators can be used to prevent future injuries, but only based on data from injuries having already occurred.
In high-reliability operations, leading and lagging indicators again allow for deference to expertise. Those most knowledgeable of the tasks should be consulted to determine which indicators to measure and analyze, regardless of title or position.
Indicators allow for sensitivity to operations. Develop them to capture data during normal operations without interrupting workflows. Also, this allows for a commitment to resilience. Lagging indicators, despite an incident having occurred, allow for resilience from the incident and a means to determine what went wrong — whether the safe process was followed/used and whether the safe process was sufficient.
Ultimately, you must understand and implement high-reliability principles as a real-world, pragmatic, operationalized part of your operations. These must exist in every part of the operation, every day and with every team member to create a safety culture above and beyond all else.
Reference
Christianson, M.K., Sutcliffe, K.M., Miller, M.A. & Iwashyna, T,J. (2011). Becoming a high reliability organization. Critical Care. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388695/
Riley, J. & Van Horne, P.V. (2014). Left of bang. New York, NY: Black Irish Entertainment.
Risk assessments: The catch-all for hazard analysis. (2011). Briefings on Hospital Safety, 19(3), 1-5.
Worden, C. & Lombardo, K. (2016). Situational awareness: The often-ignored hazard control. AOHP Journal, 36(3), 8-13.
