Hi All,

It's been really interesting learning about the traits of a high reliability organization (HRO) while working on this project. I don't know if I would have been able to come up with any characteristics I thought were particularly attached to such an ideal let alone these five but now that I've got them they do make sense. In terms of my project I think it supports each of the attributes but likely some more than others.

Sensitive to operations- This project stemmed from empathy but was quickly focused on reviewing the operations and what needed to be improved. It has been a series of reviews with questions like "How is this currently impacting our work?" and "How is it impacting the work of others?" While we were receiving all of these referrals there were many other people out there sending them to us. Working with a few network PCPs was very effective in making sure we were being sensitive to the needs of others within the system.

Reluctant to accept "simple" answers for problems- This branched out of sensitivity to operations to a certain degree. We were reviewing how/why our expectations for referrals were not being met. Were our standards too high? Were other people just not trying hard enough? Was it unclear what was needed in the prior system? Was it a bit of all three? That's roughly where we landed. It was definitely the most complex answer but it was the most realistic. We were then able to move into focusing on how to fill the gaps in knowledge and expectations.

Preoccupied with failure- We were constantly asking what we could do better with this project. What is going to go wrong? How can we get ahead of that? I'm sure we thought of dozens of ways this could get much worse before it would get better. Of course this really just spurred us into working even harder.

Defer to expertise- This is one area where I was pretty impressed with our department, especially our then practise supervisor. I had brought up the idea of this project a few times and when we finally were able to move forward with it she stepped back to let me and two of our nurses take the lead. She was still involved but was also aware that she spent much less time working on referrals than the three of us did. Being able to work with our senior nurse and another one of our triage nurses (who is just so clever and thoughtful) did somewhat streamline certain aspects as we were all able to speak on the subject in an educated and experienced manner.

Resilient- The iterations after iterations that this project took on, as well as the multiple attempts to start the project even earlier, make me think we were resilient. It took a lot to get the ball rolling but we kept trying over and over to make sure we were able to get this set up. Now that it is set up it is still malleable. Not to the point of being messy but enough that should changes be needed in the future they can be made without having to rebuild from the ground up again.