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Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice.

Classic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care.

Highly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care.

Dramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families.

As healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities.

This paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends.

Paul D. Bliese is currently the commander of the U.S. Army Medical Research Unit – Europe. He received his Ph.D. in Applied Social Psychology from Texas Tech University. His research interests include multilevel methodology, leadership, and occupational stress. He is a consulting editor for the Journal of Applied Psychology, and also serves on the editorial boards of Leadership Quarterly and Organizational Research Methods. His work has appeared in the Human Performance, Journal of Applied Psychology, Journal of Applied Social Psychology, Journal of Occupational Health Psychology, Journal of Organizational Behavior, and Organizational Research Methods.Kristina A. Bourne is a doctoral candidate in Organization Studies at the University of Massachusetts at Amherst, where she also obtained a M.B.A. and a Women’s Studies Graduate Certificate. Her academic interests include gender and organization as well as family-friendly policies and benefits. She is currently working on her dissertation in the area of women business owners, and on a collaborative research project focusing on part-time work arrangements.Gilad Chen is an Assistant Professor of Psychology at the Georgia Institute of Technology. He received his Ph.D. in Industrial-Organizational Psychology from George Mason University. His research focuses on work motivation, teams, and leadership, with particular interests in modeling motivation and performance in work team contexts and the examination of multilevel organizational phenomena. His work has appeared in the Academy of Management Journal, Human Performance, Journal of Applied Psychology, Journal of Organizational Behavior, and Organizational Research Methods.Jae Uk Chun is a doctoral student in Organizational Behavior in the School of Management at the State University of New York at Binghamton, where he is also research assistant of the Center for Leadership Studies. His major research interests include leadership, group dynamics and group decision-making, and multiple levels of analysis issues.Vinit M. Desai is a doctoral student and researcher in Organizational Behavior and Industrial Relations at the Walter A. Haas School of Business, University of California at Berkeley. His research interests include organizational learning, sensemaking, and error cognition in high reliability organizations.Shelley D. Dionne is an Assistant Professor of Organizational Behavior and Leadership in the School of Management at Binghamton University, and a fellow in the Center for Leadership Studies. She received her Ph.D. in Organizational Behavior from Binghamton University. Her research interests include leadership and creativity, levels of analysis issues, and team development and training.Daniel G. Gallagher (Ph.D. – University of Illinois), is the CSX Corporation Professor of Management at James Madison University in Harrisonburg, Virginia. He currently serves on the editorial boards of the Journal of Organizational Behavior, Journal of Management, and Industrial Relations (Berkeley). His current research interests include the multi-disciplinary study of contingent employment and other forms of work outside of the traditional employer – employee relationship.David A. Hofmann (Ph.D., The Pennsylvania State University) is currently Associate Professor of Management at the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. His research interests include safety issues in organizations, multi-level analysis, organizational climate/culture and leadership, content specific citizenship behavior, and the proliferation of errors in organizations. In 1992, he was awarded the Yoder-Heneman Personnel Research award by the Society for Human Resource Management. His research appears in a number of journals including the Academy of Management Journal, Academy of Management Review, Journal of Applied Psychology, Journal of Management, Organizational Behavior and Human Decision Process, and Personnel Psychology. He has also co-authored several book chapters, edited a book (Safety and Health in Organizations: A Multi-level Perspective), and presented papers/workshops at a number of professional conferences.James G. (Jerry) Hunt (Ph.D. University of Illinois at Urbana-Champaign) is the Paul Whitfield Horn Professor of Management, Trinity Company Professor in Leadership and Director of the Institute for Leadership Research at Texas Tech University. He is the former editor of the Journal of Management and current Senior Editor of The Leadership Quarterly. He founded and edited the eight volume leadership symposia series, and has authored or edited some 200 book and journal publications. His current research interests include processual approaches to leadership and organizational phenomena and the philosophy of the science of management.Kimberly S. Jaussi is an Assistant Professor of Organizational Behavior and Leadership in the School of Management at Binghamton University and a fellow in the Center for Leadership Studies. She received her doctorate from the Marshall School of Business at the University of Southern California. Her research interests include unconventional leader behavior, creativity and leadership, identity issues in diverse groups, and organizational commitment.Lisa M. Jones is a doctoral candidate in Organizational Behavior at the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. She received her B.A. from the University of California at Berkeley and her M.B.A. and M.A. from Brigham Young University. Her research interests include leadership, collective personality, and innovation implementation.Kyoungsu Kim is Associate Professor of Organization in the College of Business Administration, Chonnam National University. His major fields of interest are culture and leadership at multiple levels of analysis. His research focuses on charismatic leadership, organizational structure, roles, culture, and multiple levels of analysis.Barbara S. Lawrence is Professor of Human Resources and Organizational Behavior at the UCLA Anderson Graduate School of Management. She received her Ph.D. from the Sloan School of Management at MIT. Dr. Lawrence’s current research examines organizational reference groups, the evolution of organizational norms, internal labor markets and their effects on employees’ expectations and implicit work contracts, and the impact of population age change on occupations.Craig C. Lundberg is the Blanchard Professor of Human Resource Management at Cornell University’s School of Hotel Administration. He works with organizations facilitating organizational and personal development and publishes extensively (over 200 articles and chapters, five co-authored books). His current scholarship focuses on organizational change and culture, consultancy, alternative inquiry strategies, and sensemaking and emotions in work settings.Kenneth D. Mackenzie is the Edmund P. Learned Distinguished Professor in the School of Business at the University of Kansas. He is also the President of a pair of consulting companies which support and enrich his research. He is a Fellow of the American Association for the Advancement of Science. He serves on various editorial boards and has published numerous books and articles. He received a B.A. in Mathematics and a Ph.D. in Business Administration from the University of California at Berkeley. He has spent his career trying to overcome the handicap of “excessive theoretical education.”Peter Madsen is a doctoral student at the Walter A. Haas School of Business, University of California at Berkeley. His thesis work examines the processes by which organizations attempt to learn from past failures and the organizational actions and characteristics that facilitate such learning. His other interests include organizational reliability, strategic management, the work-life interface, and ethics.John E. Mathieu is the Northeast Utilities and Ackerman Scholar Professor of Management at the University of Connecticut. He received a Ph.D. in Industrial/Organizational Psychology from Old Dominion University in 1985. He has published over 50 articles and chapters on a variety of topics, mostly in the areas of micro- and meso-organizational behavior. He is a member of the Academy of Management, a Fellow of the Society of Industrial Organizational Psychology, and the American Psychological Association. His current research interests include models of training effectiveness, team and multi-team processes, and cross-level models of organizational behavior.Sara Ann McComb is an Assistant Professor of Operations Management at the University of Massachusetts at Amherst. She obtained her Ph.D. in Industrial Engineering at Purdue University. Her research interests include alternative work arrangements and project teams. Currently, she is examining mutually beneficial links between organizations and part-time workers, particularly in the service sector. She is also studying the way in which project teams share information, a project for which she was award the National Science Foundation’s CAREER Award.Jone L. Pearce is Professor of Organization and Strategy in the Graduate School of Management, University of California, Irvine. She conducts research on workplace interpersonal processes, such as trust, and how these processes may be affected by political structures, economic conditions and organizational policies and practices. Her work has appeared in over seventy scholarly articles and her most recent book is Organization and Management in the Embrace of Government (Erlbaum, 2001). She is a Fellow of the Academy of Management and served as the Academy’s President in 2002–2003.Amy E. Randel is an Assistant Professor and the Coca-Cola Fellow in the Calloway School of Business & Accountancy at Wake Forest University. She received her Ph.D. in Organizational Behavior from the Graduate School of Management at the University of California, Irvine. Her research interests include identity in organizations, diverse group dynamics, group efficacy, cross-cultural management, and social capital.Richard Reeves-Ellington is currently Professor Emeritus in the School of Management at Binghamton University and an Associate Dean at Excelsior College. He taught at the American University in Bulgaria and Sofia University in Bulgaria as a Fulbright Senior Scholar. His fields of interest revolve around cross-cultural aspects of global organization, marketing, and business strategy. He also served on the Fulbright Selection Committee for SE Europe, the Muskie Foundation for students from the CIS, and the Fulbright Senior Scholars Program. His initial 33-year career in the pharmaceutical industry included 19 years of living in Asia, Europe, and Latin America.Christine M. Riordan is a faculty member in the Department of Management and also the Director of the Institute for Leadership Advancement in the Terry College of Business at the University of Georgia. Chris’ current research, which includes the study of labor force and cross-cultural diversity, has been published in journals such as the Journal of Applied Psychology, Journal of Management, Organizational Research Methods, and Research in Personnel and Human Resource Management.Karlene H. Roberts is a Professor of Business Administration at the Walter A. Haas School of Business, University of California, Berkeley. She has been on the review boards of many major journals in her field. She is a fellow of the American Psychological Association, the American Psychological Society and the Academy of Management. Her current research interests are in the design and management of organizations in which errors can have catastrophic outcomes. In this area she explores cross-level issues.Denise M. Rousseau is the H. J. Heinz II Professor of Organizational Behavior and Public Policy at Carnegie Mellon University. An organizational psychologist, her research focuses on worker-employer relationships and multi-level processes in organizational change. She is editor-in-chief of the Journal of Organizational Behavior, and in 2003–2004, President of the Academy of Management.Melissa Woodard Barringer is an Associate Professor of Management at the University of Massachusetts at Amherst. She obtained her Ph.D. in Industrial and Labor Relations at Cornell University. Her research interests are in the areas of total compensation and alternative work arrangements. She is currently studying part-time work in the service industry, and contingent work in the accounting and academic professions.

The McComb, Barringer and Bourne article provides an insightful review of recent developments in the part-time full-time research literature and suggests a cross-level model and research approach. Building and enriching on this model, this paper first offers suggestions about variables that might be included in research on part and full-time workers, with a focus on individual-level constructs. Second, suggestions are presented about ways to add methodological richness to this area of research.

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.

High-reliability performance and high-hazard are intertwined in High-Reliability Organizations (HROs) operations; these organizations are highly safe, highly hazardous and highly significant for the modern society, not only for the valuable resources they have, but also the indispensable services they provide. This research intend to understand how HROs could produce high quality performance despite their challenging and demanding contexts. The research followed an emic approach to develop an organizational framework that reflects the contribution of the seeming traits of the organizations to the operations safety based on the workers point of views about the safety of workstations.

This research adopted mixed methods of in-depth interviews and literature review to identify the structural characteristics of high-reliability organizations (HROs) embedded in the organizations studies and developed a theoretical based structural framework for HROs. Furthermore, a systemic literature review was adopted to find the evidence from the organizations literature for the identified characteristics from the interviews from the first stage. The setting for this study is six Chinese power stations, four stations in Hubei province central China and two stations in the southern China Guangdong province.

The organizational framework is a key determinant to achieve high-reliability performance; however, solely it cannot explain how HROs manage the risks of hazard events and operate safely in high-hazard environments. High-reliability performance is attributed to the interaction between two sets of determinants of safety and hazard. The findings of this research indicate that HROs systems would be described as reliable or hazardous depending on the tightly coupled setting, complexity, bureaucracy involvement and dynamicity within the systems from one hand, and safety orientation, failure intolerance, systemwide processing, the institutional setting and the employment of redundant systems on other hand.

The authors developed an organizational framework of organizing the safety work in HROs. The applied method of interviewing and literature review was not adopted in any other researches.

Organizations in need of strategic turnaround often seek charismatic leaders to lead change efforts. With the growing popularity of democratizing workplaces, team‐based approaches to strategic change are emerging. The literature on each of these change approaches is reviewed. Several research propositions are offered which suggest that strategic teams can be a better choice than charismatic leaders for turning around an organization. The authors also note the need for future research to compare the effectiveness of charismatic leaders with the effectiveness of strategic teams in planning and initiating strategic change.

Manufacturing companies increasingly have to deal with uncertainty and complexity without being sufficiently prepared for it. High-reliability organizations (HROs) successfully deal with dynamic and unknown situations. The authors ask the question whether learning concepts of HROs can be a role model for manufacturing companies and if their learning principles can be successfully applied there. The paper aims to discuss these issues.

The authors’ research is based on high-reliability theory and former qualitative empirical studies on learning and development of mission-based HRO. The authors compare their learning practice with learning and development demands of the own empirical cases studies of three manufacturing firms.

Learning concepts in the manufacturing firms are disconnected from their practical demands. In HRO in contrast, learning and development follows a distinct choreography, with a focus on collective reflection. Manufacturing firms can learn from HROs about learning principles especially with respect to collective reflection-on-action in order to develop situational awareness. However, the HROs’ learning should not be seen as a strict role model as their work organization differs significantly from that of manufacturing firms.

The research is based on in-depth case analyses (e.g. interviews and observation). The outcomes are case specific and focus on manufacturing firms. Hence, only patterns or principles can be generalized. To gain a more complete picture, the authors suggest further case analyses in different industries.

Manufacturing firms can benefit from learning principles of HROs, like combining formal and informal learning and collective reflection on practice.

The paper connects previous research on HRO with original empirical research on manufacturing firms. Through the matching of data, the authors contribute to the discussion on whether the concept of HROs can be seen as a role model for learning and development in manufacturing firms.