Over 20 years ago, in its enduringly impactful report To Err is Human, the US Institute of Medicine (IOM) claimed that healthcare is not unique among high-risk, high-reliability industries, pointing out that it too is concerned with learning how to prevent, detect, recover and learn from mistakes and accidents. That observation was based on research conducted by an interdisciplinary group at the University of California at Berkeley who were ‘curious about the seemingly theory-defying ability of some organizations to avoid catastrophic operational outcomes despite operating technologies that were fraught with exceptionally high levels of risk, uncertainty, hazard, and public intolerance of failures’. Although functionally different, these ‘high reliability organizations’ (HROs) achieved exceptionally high and sustained levels of performance as a consequence of deliberate, ongoing, organisational efforts characterised by the five principles of: preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience and deference to expertise. HROs are adaptive organisational forms for complex environments; the ways in which they organise are considered to be a ‘dormant infrastructure for performance improvement in all types of organizations’. HRO-related research has proliferated in the last two decades and has had remarkable impact on research, policy and practice across multiple industries—especially healthcare.

Both authors contributed equally