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This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

The study investigated the predictive role of supportive leadership and psychological safety for mindful organizing and the subsequent impact of mindful organizing on individual task performance. Mindful organizing, a concept from high-reliability organizations (HROs), can improve performance in various industrial settings. The limited availability of novel predictors for mindful organizing necessitates exploring this concept in the context of adventure tourism.

Through a cross-sectional research approach, 394 respondents were selected from the adventure tourism industry in Malaysia. The proposed causal research model was evaluated through structural equation modeling (SEM), aggregation and bootstrapping.

Psychological safety and supportive leadership significantly impacted mindful organizing. Mindful organizing, in turn, was positively associated with individual task performance. The mediating role of mindful organizing between psychological safety and task performance was statistically significant. However, the mediating role of mindful organizing between supportive leadership and task performance was not statistically significant.

Managers in the adventure tourism industry should consider applying mindful organizing to increase employee productivity and develop collective sensemaking. Also, developing a culture of support among managers and coworkers, emphasizing the team's psychological safety, may boost the morale and productivity of the workforce.

This research has identified and empirically tested new antecedents, psychological safety and leadership for mindful organizing in the adventure tourism context and has addressed a significant research gap (Sutcliffe et al., 2016) by broadening the scope of mindful organizing research to encompass contexts beyond those exclusively considered HROs.

Organizations working in high-hazard environments contribute significantly to modern society and the economy, not only for the valuable resources they hold but also for the indispensable products and services they provide, such as power generation, transportation and defense weapons. Therefore, the main purpose of this study is to develop a framework that outlines future research on systems safety and provides a better understanding of how organizations can effectively manage hazard events.

In this research, we developed the high hazard theory (HHT) and a theoretical framework based on the grounded theory method (GTM) and the integration of three established theoretical perspectives: normal accident theory (NAT), high reliability theory (HRT) and resilience engineering (RE) theory.

We focused on the temporal aspect of accidents to create a timeline showing the progression of hazard events and the factors contributing to safety and hazards in organizations. Given the limitations of the previous theories in providing a coherent explanation of hazard event escalation in high-hazard organizations (HHOs), we argue that the highlighted theories can be more complementary than contradictory regarding their standpoints on disasters and accident prevention.

A proper appreciation of the hazard nature of organizations can help reduce their susceptibility to failure, prevent outages and breakdowns of systems, identify areas for improvement and develop strategies to enhance performance.

By developing HHT, we contribute to systems safety research by developing a new, refined theory and enrich the theoretical debate. We also expand the understanding of scholars and practitioners about the characteristics of organizations working in high-hazard environments.

Organizational exploration has recently emerged in the literature as an essential aspect of contemporary organizations. However, little is known about its antecedents and, specifically, the role of contemporary leadership styles. The present study investigates the relationship between empowering leadership and organizational exploration. In addressing this relationship, we examine preoccupation with failure and leader gender as a mediator and a moderator, respectively.

We collected data from a sample of 326 US employees in March 2022. To test the present hypotheses, we used the PROCESS SPSS macro.

Our results supported our moderated mediation model, demonstrating that the indirect relationship of empowering leadership with organizational exploration via preoccupation with failure is stronger for male leaders than for female counterparts.

Concerning the practical implications of this study, organizations should be cognizant of empowering leaders’ impact on desirable outcomes. Additionally, organizations should promote preoccupation with failure to ameliorate organizational exploration. Preoccupation with failure can be achieved when error reporting is encouraged by organizations and supervisors and when a culture that promotes constructive feedback is established.

The present study offers novel insights into the underlying mechanisms and boundary conditions through which empowering leadership relates to organizational exploration. Additionally, it fills a gap in the literature concerning the relationship between empowering leadership and preoccupation with failure. Moreover, it adds to prior research regarding the outcomes of preoccupation with failure, filling the gap regarding the relationship between preoccupation with failure and organizational exploration. Lastly, it expands limited research focused on leader gender as a condition under which the effect of contemporary leadership styles could be enhanced or mitigated.