Safety Science: the key differentiator behind every High-Reliability Organization (HRO)
Core Concept
Safety science is central to high-reliability organizations (HRO). It is the interdisciplinary study of accidents and accident prevention, drawing on fields such as engineering, physical sciences, epidemiology, sociology, psychology, anthropology, and neuroscience. This comprehensive approach ensures that every aspect of potential failure is considered.¹
Key Differentiator
What sets HRO apart from standard quality management solutions is its focus on the science of accidents and their prevention. The methodologies behind every HRO have been shaped by analyzing thousands of significant events, emphasizing the need for broad solutions targeting human error and organizational culture in high-risk, complex systems.¹ Although some of the leadership practices are similar to other process improvement methods, the use of the tools and techniques are different, along with a focus on investigations of events.²
Safety Management System (SMS)
Safety Management Systems (SMS) represent best practices and have become the standard in many industries for managing risk and ensuring the effectiveness of risk controls. An SMS is a formal, top-down, organization-wide process that requires organizations to manage safety with the same priority as other core business processes. This structured approach reflects an evolutionary process in system safety and management.³
Evolution and Impact
Paradigm Shifts: Aviation, nuclear power, and manufacturing have evolved from focusing solely on equipment technology and processes to improving safety through understanding human factors. As systems became more complex, human error became the main contributor to significant events. System engineers shifted their focus to human limitations and capabilities, leading to the current emphasis on organizational factors such as resource management, time pressures, organizational structures, system capacity, policy usability, environmental and technological factors, process design, and, most importantly, organizational culture.
1999: The SMS framework was introduced to healthcare by Craig Clapper and Kerry Johnson, system engineers who originally worked with Dr. Chong Chiu's organization, Performance Improvement International (PII).
FUN FACT
PII is responsible for designing and implementing the approach for the nuclear power industry. Their work studied by researchers Karlene Roberts, Kathleen Sutcliffe and Karl Weick, and others. Sutcliffe and Weick’s work are most well-known for giving the name HRO to organizations who operated in high-risk high consequence environments regularly and manage to stay ultra-safe. The name HRO given to industries such as nuclear power, aircraft carriers, and firefighting, has since evolved as a “template” for other industries including healthcare to help organizations achieve the emergence of safety and reliability.
2019: Clapper, a founder of Healthcare Performance Improvement (HPI) and pioneer of the nuclear power and healthcare safety and high-reliability solutions, and team published their approach and client successes in the book "ZERO HARM – How to Achieve Patient and Workforce Safety in Healthcare" (2019).⁴
2019: The Department of Veterans Affairs, Veterans Administration Health Services Research & Development Service documented the impactful HRO work, and results pioneered by Clapper and Johnson.⁵
2021: Craig Clapper and Tamra Strong, a former HPI consultant, Vice President, and thought leader, co-founded Reliability 4 Life Group. They published an overview of their framework in the fifth edition of "The Healthcare Quality Book: Vision, Strategy, and Tools" by Joshi, Ransom, Ranson, and Nash in 2023.⁶ Together, they continue to advance the methodology and SMS framework to align with the complexity of healthcare delivery systems and the highest standards of "World-Class Safety Management Systems."
Dynamic Nature of Safety:
Safety is a dynamic and emergent property of complex systems. An SMS ensures management accountability, involvement, systems thinking, and provides ways to manage, control, and monitor the system effectively.
Learn More:
To read more about the differences between quality management (process improvement methodology) and Safety Management Systems, click here.
For more information on World-Class Safety Management Systems, click here.
To learn more about the Reliability 4 Life World-Class Safety Management System, contact us.
For additional Reading:
Dekker, S. (2019). Foundation of Safety Science: A century of understanding accidents and disasters.
Flight Safety Information February 12, 2010 NO.034 Lessons Learned from Toyota-2010-QMS vs. SMS.
Federal Aviation Administration, United States Department of Transportation (March 2022). Safety Management System (SMS).
Zero Harm: How to Achieve Patient and Workforce Safety In Healthcare, McGraw-Hill, 2018. (Craig Clapper); Chapter 9 (Tami Strong) – Learning Systems, Zero Harm: How to Achieve Patient and Workforce Safety in Healthcare, McGraw-Hill, 2018.
Veazie, S., Peterson, K., Bourne, D. (May 2019) Evidence Brief: Implementation of High-Reliability Organization Principles. Prepared for Department of Veterans Health Administration Health Services Research & Development Service.
Chapter 5 Clapper, C., Strong, T. - Safety Science and High-Reliability Organizing, The Healthcare Quality Book 5th edition, Dr. David Nash editor, Health Administration Press, 2023.