Whilst organisation to the next (Chassin, 2013;


Whilst there have also been growing efforts to transfer the core HRO principles into healthcare practice, there is a general literature consensus regarding the feasibility of application in such a comprehensive domain. It is stressed that suitability is likely to be context-dependent varying highly at the local scale (Lekka, 2011). Tamuz (2006), highlights multiple challenges fronting the successful implementation of certain HRO principles into practice within this sector. The example of redundancy, in the form of cross-checking, is shown to be counter-intuitive having negative effects on system operations echoing Sagan’s (1993) NAT interpretation that unnecessary ‘system slack’ is produced. Double-checking medication is a common practice within healthcare organisations, yet it is argued that an excessive reliance on this measure may facilitate a ‘culture of complacency’ whereby individuals diffuse their sense of responsibility and over-rely on others duplicate labours (Tamuz, 2006). This stresses what many researchers argue, the central attributes of HRO principle implementation “remain unarticulated” (Weick, 2005; Tamuz, 2006). Thus, advancements in hospital safety are likely to spatially and temporally vary, so ‘high reliability’ should be recognised not as a state of achievement but rather a continual process in organisational operations, that is not instantaneous and cannot simply be ‘lifted’ from organisation to the next (Chassin, 2013; Christianson, 2011, Woodhouse, 2015; Tamuz, 2006).While Roberts (2005) discusses the successful implementation of HRO principles in a PICU spanning an eleven-year period, he additionally emphasises how easily these processes can fail with projects suffering from ‘fatigue’ overtime (Chassin, 2013). The replacement of staff with those lacking HRO training resulted in a reversion to the traditional ‘Medical model’ whereby ‘physician culture’ dominates and team positions are determined by expertise status-level (Robert, 2005). Thus, it is evident that the broader socio-political context in which HRO operate is likely to be an increasing impediment that will limit the successful application of HRO principles in any given setting. La Porte (1996), discusses this through classifying HRO’s as ‘Large technical Systems’, whose scope has expanded dramatically in both number and complexity over the past century. With this complexity rises progressively demanding information requirements and economic investments in terms of processes and employees. Thus, the ability to enforce ‘reliability enhancing’ practices becomes challenging to maintain and wholly dependent on the current state of financial and political ‘legitimacy’ (La Porte, 1996). HRO theory is consequently regarded as a ‘systematic approach’ to viewing human error whereby the focus is on system conditions, under which individuals operate, and the ability of that system to anticipate and contain potential failings (Reason, 2000). The overarching ethos within the literature is one illustrating the successful ‘progression’ of systems towards applying HRO principles in domains such as Health Care and UK Oil Refineries. Nevertheless, the concept has arguably been transformed into a ‘touchstone’ whereby modern organisations may only ever be seeking and not achieving reliability (Hopkins, 2007). 



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