What are High Reliability Organizations?

High Reliability Organizations, or HRO’s, are organizations that are required to:

“…operate in an unforgiving environment, rich with the potential for error, where the scale of consequences precludes learning through experimentation and where complex processes are used to manage complex technology in order to avoid failures.”

Human Factors

Human factors is the term used to describe the interaction of individuals with each other, with facilities and equipment, and with management systems. This interaction is influenced by both the working environment and the culture of the people involved. What may be a good system of work in one part of an organization, may be found to be less than ideal in a region where culturally driven attitudes to risk taking may be significantly different. Human factors analysis focuses on how these interactions contribute towards the creation of a safe workplace.

Crew Resource Management and the Aviation Safety Model

The “inspiration” for Crew Resource Management had its roots in the commercial aviation industry. A series of tragic airline crashes in the 1960s, ‘70s and ‘80’s led investigators and regulators to discover that many of these crashes were completely avoidable. The National Transportation Safety Board (NTSB) concluded that:
“The majority of the accidents where flight crew actions/inactions were prime causative factors… could be attributed to inadequacies in leadership qualities, communication skills, crew coordination and decision-making … as opposed to technical proficiency failures”
This led to the recommendation that flight crews receive training in “Cockpit Resource Management” (CRM) to address these inadequacies. CRM was later redefined as “Crew Resource Management” to include cabin crews and flight dispatchers. The NTSB recommendations were adapted by the Federal Aviation Administration (FAA) and now all commercial airline operators are required to receive CRM training CRM has had a huge impact on the reduction in accident rates in the commercial airline industry and is now required for charter operators (FAA Part 135) as well. The International Business Aviation Council (IBAC) has made CRM training a requirement for membership and CRM training is now required for just about any crew working for hire throughout the world. The benefits of CRM and the Aviation Safety Model, as it has come to be known have been recognized by virtually every high-risk industry. The human factors concepts that transform a high risk industry to a high reliability organization transcend any specific industry or discipline. They are not specific to aviation or any other discipline and are truly universal in form and function. Crew Resource Management (CRM) was introduced to commercial aviation in the United States in the 1980s. The overwhelming success of CRM at reducing accident rates eventually captured the attention of professionals in other high-risk industries. As it turns out, many of the lessons learned from CRM training and application in the aviation industry, can be directly applied to any High Reliability Organization. Any profession, organization or activity that involves a level of risk where the consequences of error can be significant – even fatal – can be considered a High Reliability Organization (HRO). “Assuring high performance in an increasingly complex world requires good management of unexpected threats that can escalate out of control.” (Weick & Sutcliffe, 2001). HROs use proven effective risk management techniques to avoid catastrophes in an environment where accidents can and do occur due to risk factors and complexity. Such organizations include Transportation, Energy, Healthcare, Defense, Chemical Safety and many more…


The Aviation Safety Model is well established in almost every sector of aviation. In North America, Europe and many other areas of the world, pilots, flight attendants, mechanics, dispatchers, ground handlers and controllers all receive some level of CRM training. CRM is even identified as a key training element in the space program (called “Space Resource Management”). Other transportation industries that have benefitted from CRM training include, Rail and Maritime (Bridge Resource Management).


Health care professionals work in a complex environment. Care of patients in high-acuity areas, such as intensive care units, emergency rooms, operating rooms, and labor and delivery suites, require the constant input of expertise from individuals with varying backgrounds and training. Anesthesiologists, nurses, surgeons, pediatricians, intensivists, respiratory therapists, attendants, and technicians need to work with each other to deliver care in the safest possible manner. Yet, when these highly qualified individuals train in their formative years, hardly any attention is spent on role crossover and they often do not have a clear appreciation of each other’s priorities and responsibilities. Much like the aviation industry prior to embracing CRM, healthcare professionals have long been conditioned to function as responsible individual experts taking responsibility, credit, and blame for individual actions.

The CRM model focuses on the safety, efficiency, and morale of people working together. CRM training is an international requirement for nearly all aviation employees. CRM has moved aviation training beyond the limited focus of technical flying to broader dimensions of human factors engineering, fatigue and stress management, effective communication, shared awareness, and teamwork. Airline crew members consistently cite CRM training as relevant, useful, and effective in changing attitudes and behaviors to improve safety.

It has been demonstrated that safety-related behaviors that were successful in aviation are just as relevant in health care. Researchers have proposed a translation of teamwork behaviors from aviation to health care by the application of “countermeasures”—briefings, debriefings, standardized communication language and process, workload distribution, fatigue management, inquiry, graded assertiveness, contingency planning, and conflict resolution—introduced in CRM training.

CRM applications in a simulated work environment have been applied in ORs, labor and delivery units for neonatal resuscitation, and hospital emergency departments (EDs). CRM training has been undertaken for multiple medical disciplines in large health systems with great success.
To bolster this position, in 2012, we published a very popular book on the subject of applications of CRM to the healthcare industry, Beyond the Checklist: What Else Healthcare Has to Learn from Aviation Teamwork and Safety. The book makes the case for how lives could be saved and patient care and safety enhanced by adapting the relevant lessons of aviation safety and teamwork.

Play Video


As with Transportation and Healthcare, the various energy sectors stand to reap significant gains by adaptation of the Aviation Safety Model. The oil and gas industry, for example, has traditionally functioned with a teamwork culture and many operations are managed by crews, shifts and groups that are required to work together.

The CRM training approach has been adapted for use in industrial settings such as nuclear plants and offshore oil installations, particularly in control rooms and emergency command centers. CRM enhances team members’ understanding of human performance, in particular the social and cognitive aspects of effective teamwork and good decision making. This training is designed to reduce operational errors, which could cause an accident, and to give crews additional skills to deal with problems if they are faced with an emergency.

Defense & First Responders

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.