High reliability and implications for nursing leaders.

AIM: To review high reliability theory and discuss its implications for the nursing leader.

BACKGROUND: A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety.

EVALUATION: The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations.

KEY ISSUES: Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries.

CONCLUSIONS: Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.