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High-Reliability Organizations

The Next Frontier in Healthcare Quality and Safety

Polonsky, Marisa S.

doi: 10.1097/JHM-D-19-00098

EXECUTIVE SUMMARY Influential health systems, regulatory bodies, and researchers have initiated a discussion over the past decade about translating the tenets of high-reliability organizations to healthcare. Nuclear power plants and the aviation industry have received the most attention for using tragedies, like the Chernobyl nuclear disaster and avoidable plane crashes, to drive the adoption of a high-reliability mindset. Despite documentation of serious adverse events and research on the key principles of high-reliability organizations, the healthcare sector has not fully committed to achieving zero harm. The goals of this essay are to summarize how high reliability differs from other improvement methodologies, explore the imperative to commit to high reliability, address barriers to adoption, provide practical recommendations for implementation, and predict what can be achieved from this investment.

University of Iowa College of Public Health, Iowa City

Ms. Polonsky is the first-place winner of the graduate division of the 2019 ACHE Richard J. Stull Student Essay Competition in Healthcare Management. For more information about this competition, contact Sheila T. Brown at (312) 424-9316.

For more information regarding the concepts in this essay, contact Ms. Polonsky at

The author declares no conflicts of interest.

© 2019 Foundation of the American College of Healthcare Executives
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