In collaboration with the Greater New York Hospital Association

The High Reliability Leadership Forum, funded by a grant to Greater New York Hospital Association from UHF, brings together senior leadership from 11 GNYHA member hospitals to develop strategies and action plans for facilitating sustainable change at their organizations that can promote principles of high reliability, foster a culture of safety, and achieve zero harm.

Why This Is Important

Principles of high reliability have been in place in other industries, such as nuclear power and commercial aviation, for several decades. As in those fields, health care is a highly complex undertaking in which failure can have dangerous consequences. Health care organizations are increasingly emphasizing the use of high-reliability organizing principles as a way of establishing a culture of safety and a commitment to performance improvement. The five principles of high reliability are: 1) continuous and heightened attention to anomalies that could become larger safety problems, 2) reluctance to simplify or generalize a problem, instead seeking underlying explanations, 3) sensitivity to operations to ensure situational awareness, 4) deference to expertise, with an understanding that the people closest to the work are likely to be the most knowledgeable, and 5) commitment to resilience, to account for the unpredictable nature of potential safety threats.

The Work

The ten-month initiative incorporates a mix of didactic learning and facilitated team-based exercises on topics such as high-reliability organizations’ characteristics and patient engagement, leadership behaviors, building a culture of safety, and performance improvement strategies. After completing an initial baseline assessment of their current practices, participating hospitals are focusing on developing organization-wide action plans that will enable them to move toward becoming high-reliability organizations. Erin DuPree, MD, FACOG, former CMO of the Joint Commission for Transforming Healthcare, serves as faculty to the learning collaborative.

The Bottom Line

High-reliability organizations focus on organizing their workforces to achieve reliable performance in real time—emphasizing ways that people, processes, and practices can coalesce toward the goals of improving safety and achieving zero harm. They also operate in complex and dynamic environments and focus on avoiding adverse events for extended periods of time. Achieving high reliability requires commitment from leadership at the highest level to shape a definition of harm and vision of functioning that filters down to and is shared by all levels of staff. This initiative is engaging leadership in focusing on this issue and providing a structure for achieving measurable change in their organizations.

Key Questions

The initiative will address several key questions:

  • What does high reliability mean in health care?
  • How can organizations engage patients for high reliability?
  • What does it take to incorporate high-reliability leadership behaviors?
  • How can agreed-upon definitions of harm, safety, and high reliability be established?
  • What are the essential steps for engaging staff in the high-reliability transformation process?

Looking Ahead

At the end of the initiative, participants will have developed and begun implementing action plans for incorporating principles of high reliability in their organizations’ structure, and working toward achieving zero harm.


Participating Facilities

Blythedale Children’s Hospital

Bronx-Lebanon Hospital Center

Hackensack Meridian Health

Interfaith Medical Center

Jamaica Hospital Medical Center / Flushing Hospital Medical Center

John T. Mather Memorial Hospital

Kingsbrook Jewish Medical Center

NYC Health + Hospitals/Coney Island

NYC Health + Hospitals/North Central Bronx

SBH Health System

University Hospital, Newark, NJ


Contact: Joan Guzik, Pooja Kothari