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Rethinking high reliability in healthcare: The role of error management theory towards advancing high reliability organizing

US Healthcare, despite its exceptional technology and innovative treatments, is still unsafe and unreliable. It is estimated that medical errors account for an estimated 254,000 inpatient deaths a year and hold the distinction as the third leading cause of death in the US. Despite an aggressive national campaign set by organizations like the National Academy of Medicine, the Institute for Healthcare Improvement, the National Patient Safety Foundation, and the National Quality Forum, efforts to improve the quality and safety of US Healthcare have been unsuccessful, or at best, unsustainable at eliminating preventable patient harm. Historically, US Healthcare has turned to commercial aviation, nuclear energy, oil and gas, and other high reliability industries for lessons on how to avoid harm. In this paper, we join two pre-existing conceptual models: high reliability organizing and error management theory to propose a strategy for embedding and sustaining a preoccupation with failure and commitment to resilience within healthcare to advance a practical and disciplined focus to advance organizational high reliability.