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Purpose – To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.

Design/methodology/approach – A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.

Findings – Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.

Research limitations/implications – Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.

Practical implications – If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.

Social implications – Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.

Originality/value – The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health care organizations.

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.

Long-term stewardship (LTS), the caretaking of hazardous materials, is one of the main unanticipated challenges of high modernity. LTS refers to the process of protecting public health and the environment through the effective management of systems or materials over multiple generations, in some cases over many many generations. It arises from the recent realization that the full remediation of contaminated waste sites is beyond scientific knowledge, best technologies, or available resources.¹ Some materials will demand care and risk management over several generations while others, such as high-level nuclear waste, will require a succession of generations that exceeds the longevity of any civilization known to history.

This chapter provides an overview of the case and draws attention to the types of teams who respond to disasters, specifically a structure fire. We then provide a detailed recounting of the case, what resources were at play, and how the incident resolved.

There have been a number of case studies that have documented the challenges organizations face in monitoring complex and turbulent environments and the anomalous events that characterize them combined with multiteam systems’ unique combination of intricacy, propensity toward hazards, and necessary team cohesion makes it particularly difficult to foreshadow – and subsequently train for – all possible contingencies. The majority of the cases reported here is based on the official National Institute for Occupational Safety and Health report that occurred shortly after the event and which is a required investigation by both State and Federal laws. Although the report is publicly available, specific identifying information was removed to allow for ease of comparison and to emphasize the multiteam system processes of interest.

As outlined in the case study above, there are many challenges that were faced in this multiteam system response to the supermarket structure fire. We discuss the response of the multiteam systems and attempt to identify a few key areas where miss-steps occurred and how the response would be different when multiteam systems function properly. We conclude with some practical implications from the incident as well as how multiteam systems can be improved based on this case study.

This chapter provides a real-world example of a disaster and systematically analyzes the steps and decisions that were utilized during the process from a multiteam perspective. Hopefully, the analysis of the case presented here will assist in developing increased awareness during high-stress encounters and offer an unbiased evaluation of what is required to properly train and therefore mitigate such tragedies in the future.

The paper applies the concept of dynamic capabilities to the field of high reliability organizations and particularly to EU Taranis 2013, an international civil protection exercise.

The paper draws on the multi-level model by Wilkens et al. (Wilkens & Gröschke, 2007; Wilkens, Keller, & Schmette, 2006). In this model dynamic capabilities are based on four dimensions of competence at individual, team, and organizational level. In a survey-based analysis, the paper identifies the four dimensions of competence at the individual and team level in high reliability organizations at civil protection exercises.

The paper demonstrates that Wilkens et al.’s model of four dimensions of competence for analyzing dynamic capabilities can be well transferred to the field of high reliability organizations.

Transferring the competence model of dynamic capabilities to high reliability organizations has created a new field of research. The survey conducted on top executive level symbolizes a pre-test for further empirical studies in high reliability organizations including members on all organizational levels. Further research may also explore particularities of the participating teams and their frames of reference in international civil protection exercises – partly networks, partly bureaucratic systems, etc.

The concept of dynamic capabilities is highly relevant for civil protection, particularly in terms of cross-situational competences. Competences at team level are of crucial importance, because the handling of emergency cases is largely based on the cooperation of teams stemming from different rescue organizations.

Drawing from literature on organizations that function efficiently and effectively while maintaining low levels of errors and occupational injuries and deaths, we argue that police departments can enhance their legitimacy by adopting the practices found in such organizations because doing so can reduce the frequency of unnecessary force against citizens and lower officer injury rates.

To support our argument, we review literatures on the causes and avoidance of errors in organizations, identify how well-run organizations in high-risk environments are able to operate safely, and describe how police departments can adopt similar practices as a mechanism to enhance officer safety and lower the rate at which officers use force against citizens.

By adopting the practices of successful organizations in other fields, police departments and their officers can promote and enhance their safety while simultaneously reducing their use of force against citizens. By doing so, police can raise the level of legitimacy they hold in the eyes of the American public, which has arguably decreased in the wake of recent events involving police gunfire.

Our ideas contribute to the policing literature by: (1) highlighting a preexisting body of literature and outlining its application to police organizations and (2) detailing how both the police and the public can benefit from improved police practices.

This chapter describes the efforts of a team of health care workers to make a sub-acute health care facility (SCF) serving profoundly damaged children into a high reliability organization (HRO). To obtain this goal, the health care team implemented change in four behavioral areas: (1) risk awareness and acknowledgment; (2) defining care; (3) how to think and make decisions; and (4) information flow. The team focused on five reliability enhancement issues that emerged from previous research on banking institutions: (1) process auditing; (2) the reward system; (3) quality degradation; (4) risk awareness and acknowledgment; and (5) command and control. These HRO processes emerged from the change effort. Three additional HRO processes also emerged: high trust, and building a high reliability culture based on values and on beliefs. This case demonstrates that HRO processes can reduce costs, improve safety, and aid in developing new markets. Other experiences in implementing high reliability processes show that each organization must tailor make processes to its own situation (e.g. BP, U.S. Chemical Safety and Hazards Board, Federal Aviation Administration, U.S. Navy Aviation Program, and Kaiser Permanente Health Care System). Just as in the flexibility called for in organizing for high reliability operations, flexibility is called for in deciding which HRO processes work in specific situations.