• Operate in complex, high-hazard domains for extended

periods without serious accidents or catastrophic failures

• Born out of the Normal Accident Theory
• Dr. Gene Rochlin – California Berkeley
• Examples:
1. Air Traffic Control systems
2. US aircraft carriers
3. Nuclear power plants
1. Hyper-complexity
2. Tight coupling
3. Multiple levels
4. Complex communication
systems
5. High level of accountability
6. High frequency of immediate
feedback
7. Compressed time factors
8. Multiple critical outcomes
 “Ideal Scenario”

Hyper-complexity

Immediate feedback
“work arounds”
“tech failures”
“interNOTability”
Attributes of High Reliability:
1. Preoccupation with
failure
2. Reluctance to simplify
interpretations
3. Sensitivity to
operations
4. Commitment to
resilience
5. Deference to expertise
Summary:
• High risk and high effectiveness can co-exist
• Takes intensive effort to do so
• Healthcare is no different
• CHITS MM are the “gate-keepers” of safe,
effective medication use
• Rochlin, Gene I. "Reliable Organizations: Present Research
and Future Directions". Journal of Contingencies and Crisis
Management. 4 (2): 55–59. doi:10.1111/j.1468-
5973.1996.tb00077
• https://psnet.ahrq.gov/primers/primer/31/high-reliability