There is No Such Thing as a High Reliability Organization

“Become an HRO,” they say. “It’s the secret to becoming highly reliable at what you do.” Many industries suffering from higher than expected rates of failure (such as healthcare that kills 440,000 patients each year in the US alone 1) believe they can look across the fence to other industries who do well (such as aviation) and somehow learn of the secret sauce. The secret sauce does not exist. Nor does the High Reliability Organization.

Commercial airlines are often seen as the benchmark, with airplane accidents occurring less than one in every 4 million flights.2 Yet, there is more to the story. US airlines have nearly twice the national average of fatal workplace injuries, more than sixteen times that of Wall Street bankers.3 If they found the secret sauce, clearly then they would have used the secrets of HRO to make commercial aviation a safe place to work, and they would have used their HRO sauce to get schedule reliability above 90% and to even lose a few less bags.

Organizations will be reliable only around those things they value by putting in the time and resources to achieve an extraordinary level of reliability. We value our airplane not crashing – so we set up a federal agency (the FAA) to oversee the safety of airplanes and airline operations. We created expectations, such as FAR 25.1309 that require a loss of critical functions on the airplane to happen at a less than 1-in-a-billion rate.4 And we set up an enforcement scheme that meant FAA inspectors were crawling around the airline each and every day of its operation. There are very real reasons airlines crash their airplanes at 1-in-4 million rate, while simultaneously mishandling 1 in every 140 passenger’s bags.5

Even with the investment, sometimes the actual outcomes are not so good. Organizations must face up to the inherent risks associated with their business. Wall Street bankers have low injury rates in large part because being a banker is an office job. Elevator to desk, desk to elevator – who’s gonna suffer a fatal injury doing that? NASA crashed the space shuttle every 60 flights because, in very large part, space travel remains inherently dangerous. In fact, those experts who spent the time to benchmark commercial aviation v. the space shuttle found NASA’s operation to be more robust than that of US airlines, from systems they designed, to the culture they created. The central problem for NASA was taking an airplane, coating it in foam, strapping it to two roman candles and hurling it into space at 17,500 mph. Space travel is simply more dangerous than everyday airline travel.

Like us as individuals, organizations must decide what they want to be good at. Life will always be filled with competing values. Electric power utilities can reduce injury rates by not allowing their technicians to be on the road, or on the power poles, after the big snowstorm. Yet, customers want their electricity restored. So we find a balance that restores power, and keeps technician fatalities to a minimum (but nothing like that of our Wall Street banker). My typical doctor’s appointment rarely starts at the time my doctor and I mutually agreed to meet (national average wait time being 20 minutes6). We all want healthcare to be less dangerous, yet we’re willing to live with our doctor missing at the scheduled appointment time. There is no HRO sauce that will make my doctor be there for the appointment at the scheduled time. Could we have a very high level of schedule reliability within healthcare? Yes, but we’re overwhelmingly unwilling to pay the price.

We believe it’s better to think of “highly reliable outcomes.” Every organization can achieve extraordinary results around those things they choose to value. It could be service; it could be safety. It’s up to the organization to commit the resources to get there. Design great systems around employees. Build the right culture. And build in the systems of surveillance that allow the organization to learn. Broad-brush improvement efforts will move you along, but they will only get you so far. To achieve extraordinary results requires heavy lifting, one class of undesired outcome at a time. It’s real work to create great outcomes. Just ask commercial aviation.

David Marx
CEO Outcome Engenuity

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