Nevertheless, Hopkins (2007) raises the issue regarding the rigidity of Weick and Sutcliff’s HRO definition whereby organisations must exhibit all five principles to qualify, when in reality conditions are not so easily defined, and organisations will display varying principles to differing degrees (Hopkins, 2007). In other words, HRO’s should be regarded as a framework, an “ideal type” form which organisations can aspire to achieve, therefore irradiating previous disputes over whether an organisation definitively classifies as highly reliable if displaying signs of progression towards and not the attainment of HRO principles.
With this in mind, there have been numerous attempts to successfully transfer the core HRO principles to non-military contexts and assess the applicability of these ‘reliability enhancing’ processes into meaningful practice (Lekka, 2012). Gordons (2013) ‘Beyond the checklist’ suggests that patient safety in health care systems can be enhanced by adapting and incorporating appropriate HRO principles learned from aviation safety. The concept of ‘high reliability’ is appealing to healthcare sectors, most prominently intensive care units, as tasks are also completed under highly complex and fast-paced environments, where an error has potentially life-threatening consequences (Christianson, 2011). Evidence for the re-engineering of health care systems in line with HRO core principles identified from the literature is apparent in Madsen’s (2006) study of a Paediatric Intensive care unit (PICU) where increased quality of care combined with enhanced response times proved to be a direct determinant of reduced mortality rates. The implementation of staff training as a continuing design feature facilitated a decentralised decision-making structure whereby nurses were encouraged to play an active role in patient care decisions (Lekka, 2011). This response was to the growing recognition that specific expertise’s can vary from shift to shift, given the multidisciplinary nature of healthcare teams and flexible ‘traditional hierarchy’ structure (Christianson, 2011). Roberts (2005), suggests that the implementation of a reward scheme highly influenced a change in the embedded cultural behaviour of staff, encouraging greater opinion sharing and participat