Woodhouse (2015), discusses the implementation of a comprehensive accident reporting system in a large radiation oncology department whereby errors were ranked by severity level and analysed accordingly. The HRO philosophy of ‘Crisis as Safety’ and ‘preoccupation with failure’ has been argued to be most valuable for managing errors in healthcare environments where guided error training and reporting following accidents enables staff to recognise and correct future errors more consistently (Wilson, 2005). Similarly, Roberts (2005) found this to be the case in PICU, where ‘risk perception’ increased through the implementation of in-service lectures, not only after crisis events but also whilst patients appeared “physiologically quiet” in order to effectively respond to any possible ‘latent’ or ‘active’ errors (Roberts, 2005). Similarly, Lekka (2012) identifies the successful application of two HRO principles ‘resilience’ and ‘reluctance to simplify’ in regards to increased training and competence and reporting of ‘near-misses’ within the commercial context of a UK Oil Refinery. A ‘buddy-scheme’ was adapted from initial aviation safety measures, whereby trainees shadowed experienced operators in order to establish high levels of technical competence prior to placement thus developing a robust safety culture (Lekka, 2012). The encouragement of the honest reporting of ‘near-misses’ has improved organisational resilience through increasing the corporate library of captured events and thus the ability to share knowledge and learn from past incidents. Nevertheless, the company exhibited signs of an inherent blame culture and subsequent punishments for mistakes. This, therefore, inhibits an open exchange of information as discussed by Reason (2005) which limits the lessons learned from errors and expansion of an ‘informed culture’.
Whilst there have also been growing efforts to transfer the core HRO principles into healthcare practice, there is a general literature consensus regarding the feasibility of application in such a comprehensive domain. It is stressed that suitability is likely to be context-dependent varying highly at the local scale (Lekka, 2011). Tamuz (2006), highlights multiple challenges fronting the successful implementation of certain HRO principles into practice within this sector. The example of redundancy, in the form of cross-checking, is shown to be counter-intuitive having negative effects on system operations echoing Sagan’s (1993) NAT interpretation that unnecessary ‘system slack’ is produced. Double-checking medication is a common practice within healthcare organisations, yet it is argued that an excessive reliance on this measure may facilitate a ‘culture of complacency’ whereby individuals diffuse their sense of responsibility and over-rely on others duplicate labours (Tamuz, 2006). This stresses what many researchers argue, the central attributes of HRO principle implementation “remain unarticulated” (Weick, 2005; Tamuz, 2006). Thus, advancements in hospital safety are likely to spatially and temporally vary, so ‘high reliability’ should be recognised not as a state of achievement but rather a continual process in organisational operations, that is not instantaneous and cannot simply be ‘lifted’ from organisation to the next (Chassin, 2013; Christianson, 2011, Woodhouse, 2015; Tamuz, 2006).