Preoccupation with failure and adherence to shared baselines: Measuring high-reliability organizational culture

This study designed and tested two new survey instruments aligned with High Reliability Organisation (HRO) theory: 1) preoccupation with failure and 2) adherence to shared baselines.

HRO concepts (which also include the similar concept of highly reliable organising rather than a high reliability organisation) typically involves five principles or factors: 1) sensitivity to operations, 2) reluctance to simplify, 3) preoccupation with failure, 4) deference to expertise and 5) commitment to resilience.

The authors reasoned that another concept, adherence to shared baselines, was related to the HRO factors. Adherence is a type of standardisation of clinical work practices – said to help limit variability.

4,484 care providers across 14 hospitals within the same US healthcare system. Two survey instruments were developed based on preoccupation with failure and adherence to shared baselines. These were compared to a grading of patient safety and an existing safety culture survey which is implemented annually. The safety culture survey also included teamwork.

The instrument questions are shown below:

Results

Overall, this scoping study found that two performance factors – preoccupation with failure and adherence to shared baselines – had acceptable internal consistency and evidence for discriminant validity.

Both factors were significantly correlated with overall patient safety grade (indicative of concurrent validity).

They note that “preoccupation with failure was a stronger predictor of patient safety grade than safety culture and teamwork culture”. That is, their preoccupation with failure instrument had strong correlations with subjective ratings of patient safety compared to the safety culture instrument.

It’s noted that these instruments were developed to be used as either standalone instruments or as part of a larger survey instrument. The high correlation with subjective patient safety grades is a notable finding according to the authors.

Moreover, variability in findings across each of the indices is indicative of different elements of performance (or cultures) being measured – designed in these surveys to “add complementary and actionable information” at the individual, team or organisational level.

Like anything, there were several limitations. One is that data was across 14 hospitals – all were within the same provider. All data was also surveyed via perceptions; although not different to many other instruments.

Link in comments.

Authors: Etchegaray, J. M., Thomas, E. J., & Profit, J. (2019). Journal of patient safety and risk management, 24(4), 147-152.