Interventions and measurements of highly reliable/resilient organization implementations: A literature review

This reviewed literature on High Reliability Organisations (HRO) and similar approaches in Resilience Engineering (RE) from 1981 to 2020 to determine its impact.

34 articles out of 1400 met inclusion.

For background:

·?????? “There is a class of organizations that can do catastrophic harm to themselves and a larger public” and within this set, there’s a “subset which have operated extraordinarily reliably over long period of time”

·?????? “Operational reliability rivals short term efficiency as major goals in these organizations. Extraordinary attention is paid to operational reliability both because of the inherent dangers of the situation and because outcome reliability is impossible to realize without operational reliability”

·?????? The definition of HROs has changed over time, and pursued differently between high risk and non high risk sectors

·?????? “Weick and Sutcliffe (2001) characterized HROs by five hallmarks that facilitate problem detection and organizational management. They theorized that all five Hallmarks would be present in an HRO but suggested no hierarchy or precedence relative to the presence of any one over another”

·?????? The hallmarks are listed below—

·?????? “Organizations may exhibit the characteristics of an HRO to varying degrees; i.e., they may exhibit a subset of the five hallmarks in any combination” and “that all five hallmarks were not necessary to be highly reliable, and termed those organizations “reliability seeking”

·?????? RE also ran parallel in the later period of HRO theory, focusing on “the intrinsic ability of an organization or system to maintain or regain a dynamically stable state, which allows it to continue operations while under stress ‘

·?????? Hence, RE typically focuses on an “operating systems’ ability to adapt and evolve to stressors without suffering an incident or accident”

·?????? “Some research suggests that the characteristics of resilient organizations are very similar to those of HROs. For example, resilient organizations must anticipate and adapt to the potential for surprise and failure (Hollnagel et al., 2007) which is very similar to the HRO hallmarks of preoccupation with failure and commitment to resilience”, and other similarities

·?????? “Several RE researchers observed that the HRO literature informed RE research”, and “Dekker and Woods (2010) made the case that resilience is the action arm of HRO”

·?????? “The hallmarks of HRO and characteristics of RE rely on human behavior; e.g., attention to weak signals and adjustment to dynamic conditions, to take a reliable organization to the next step – highly reliable/resilient”

·?????? “HRO and RE also view the organization at different levels - HRO looks organization wide whereas RE is more task oriented”

Despite the differences between HRO and RE, “most authors noted that the differences are subtle and both theories stress proactivity, resilience, and adaptation (Haavik et al., 2019) and contain overlapping domains (situational awareness, demonstrative response to managing complex systems, organizational fluidity, maintaining a high level of operational performance and safety simultaneously) and are difficult to differentiate when seen in practice”.

Results

They found:

·?????? “Across all sectors, fifteen (44%) of the organizations implemented only one hallmark and the rest implemented multiple hallmarks”

·?????? “Only four organizations (12%) reported implementing all five hallmarks”

·?????? “Looking at the specific hallmarks with interventions, hallmarks 1 (pre-occupation with failure) and 3 (reluctance to simplify interpretations) are the most common in health care, while hallmark 1 is the most common in non-health care sectors, although the results are more evenly distributed in non-health care sectors”

·?????? “Within health care the next most intervened hallmark is deference to expertise”

·?????? The five hallmarks are said to not be discrete entities but rather there’s a lot of overlap and interpretation in each hallmark

Covering some more specific findings, they note that:

·?????? “it appears that hallmark 1, pre-occupation with failure is implemented as a measurable intervention across all sectors more often than the other hallmarks”

·?????? They say that the higher implementation of hallmarks 1 and 3 suggests that “organizations explored a strong response to weak signals as a means toward improving desired organizational outcomes, and then realized that sensitivity to operations should also be incorporated”

·?????? They also found that “commitment to resilience” had the least evidence of implementation, even though there’s a lot of tools to measure (capacity for) organisational resilience

·?????? They ponder why this may be, suggesting perhaps because commitment to resilience “relies on understanding organizational systems through process mapping and analysis, and the burden of mapping all systems would be enormous in most organizations”

·?????? And while it may be “be relatively easy to track organizational learning, which is essential for resilient organizations, understanding system redundancy, slack, and flexibility is far more laborious and may be out of reach for low or moderate risk organizations that cannot justify the financial business case”

·?????? Process redesign interventions were the most diversely used interventions and included checklists, incident/error reporting systems, and mindfulness practices with peer coaches

·?????? Organisations also redesigned product or process workflows using a variety of tools

·?????? Some organisations focused on a single HRO characteristic to improve a problem area, while others took a more holistic approach

·?????? “twelve organizations across all sectors (37.5%) attempted to interpret all the hallmarks through the lens of their operation; i.e., they determined what their organization would “be like” if they were an HRO, then implemented specific interventions to fill the gap between their current state and the desired future HRO-like state”.

Discussion

Next they discussed the findings – I’ve skipped a lot here.

For one, they argue that a challenge in comparisons in this domain is that there’s “no single resilience metric; rather, organizations adopt and adapt their established metrics to determine if various aspects of resilience are present, increasing, or decreasing”.

They point out that while Weick & Sutcliffe made no “differentiation in the importance of the five hallmarks, we found that pre-occupation with failure was the hallmark most often operationalized”, but the literature gave little indication why this was preferred.

They say that both HROs and RE “focuses on an operating system’s ability to detect, adapt, and evolve to manage stressors without suffering an incident or accident. Since stressors or disruptions need to be detected before the organization can adapt or recover, it makes sense that the HRO hallmark of pre-occupation with failure is operationalized most often”.

They also note that it’s unknown why organisations undertaking these concepts employ commitment to resilience the least – but they suggest reasons why: “one explanation could be that either resilience is addressed as a desired outcome under different initiatives, or that neutral or negative research results have gone unpublished due to publication”.

They note that an interesting aspect of implementing the hallmark reluctance to simplify revealed that while other hallmarks were often used in isolation, reluctance to simplify was only used in combination with other hallmarks. Again, it’s unknown why.

Based on the research, the provide some suggestions on an approach:

1. Communication a clear vision to all stakeholders

2. Interpret the HRO characteristic through the lens of the specific operation and use this as the basis for the gap analysis

3. Make HRO-like operations part of the organization’s strategic plan or create a separate action plan

4. Implement metrics that track progress toward the goal – achieving HRO characteristics for the organization or operation

5. Understand that transforming any operation into an HRO involves culture change, which is not a quick fix

They also found that several organisations in this sample “interpreted all five hallmarks in combination with organization or safety culture. These organizations combined the hallmarks with culture and focused on managing and measuring safety culture more so than managing or measuring the mindfulness or resiliency of the organization”.

They argue that this combination is important because “publications on HRO practice rarely show evidence that HRO can be attained, and then sustained (Lekka, 2011). The few publications focused on organizations that implemented change are lost in the hundreds of peer reviewed publications where no intervention or change was mentioned”.

Finally, they refer to one of the studies that noted the “difficulty of separating HRO interventions from other concurrent interventions, so it is hard to determine if organizational improvement is actually attributable to the mindful practices of HROs, or not. They also noted that for those organizations that improved after implementing HRO, it was difficult to determine the mechanism”.

Authors: Cantu, J., Tolk, J., Fritts, S., & Gharehyakheh, A. (2021). Interventions and measurements of highly reliable/resilient organization implementations: a literature review. Applied ergonomics, 90, 103241.