Protecting the Healthcare Ecosystem: Trademarks of High Reliability Organizations

Nick Gabriele + Ted Dow

Successful operation of healthcare facilities requires addressing and overcoming a myriad of unique challenges

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Successful operation of healthcare facilities requires addressing and overcoming a myriad of unique challenges, many of which are rooted in providing protection for a population that includes occupants incapable of self-preservation. Patient well-being necessitates that healthcare ecosystems maintain appropriate levels of safety, security and resiliency.

The healthcare ecosystem is comprised of the patient, staff, physical environment and organization’s patient care strategy. Success in protecting the ecosystem is a trademark of High-Reliability Organizations (HROs), achieved through a holistic mindset that considers potential threats from/to the physical environment, technological systems, human capital and organizational operations.

HROs demonstrate consistent success in catastrophe avoidance in environments where day-to-day accidents are expected due to typical risk factors and system complexity. Successfully limiting the impact of such accidents positively affects an organization’s safety, security, and resiliency and helps maintain its ability to provide care and protect brand reputation.

To illustrate this, consider a hospital that is planning a new patient care tower. To approach design, construction, occupancy and operation as an HRO, the following steps would be taken.

Design and Construction

Safety for patients, visitors and staff, along with efficient and resilient facility functionality, would be introduced as primary objectives early in the planning and design stages. Compliance with minimum building and fire codes is a must. But HROs set higher expectations and take a more comprehensive view.

  • Safety concerns beyond the minimum code requirements are considered and addressed. When designing smoke compartments, for example, compartment size, travel distance and barrier construction are all regulated by prescriptive codes. Looking beyond code compliance, configuration of those smoke compartments considers functional impacts, such as ensuring availability of direct fire department access or making sure compartments intended for high acuity patients (e.g., ICU) have adjacent compartments that can support those patients during an evacuation (e.g., not a business office occupancy).
  • Early in the design, a thorough Safety Risk Assessment (SRA), including a Disaster, Emergency and Vulnerability Assessment, is conducted per FGI Guidelines to inform the building’s resiliency.
  • Design and construction teams align on overall safety and functional objectives and have regular coordination throughout design and construction to ensure early recognition and prompt resolution of issues that arise. Discussion of design impacts on operations is key, including unique fire sprinkler designs, fire alarm designs, smoke control systems for atriums, security features, generator placement, capacity and patient surge spaces.
  • Understanding operational impacts beyond the physical facility, the HRO continues its holistic approach by also focusing on the technology, human and organizational aspects.

Pre-Occupancy Preparation

As construction progresses and the occupancy date nears, the HRO expands focus to ensure staff are trained to conduct effective operations on day one. The HRO develops unit-specific fire response procedures, conducts hands-on fire training with staff, and trains leadership and fire response teams. Surgical fire prevention programs and best practices for unique patient acuity (e.g., bariatric unit, NICU, behavioral health) are considered and proactive response plans are developed for emergency and catastrophic events. Relevant questions include:

  • How would the organization manage a major patient surge event (e.g., mass casualty, pandemic)?
  • If full evacuation of the tower became necessary (for example, due to major utility disruption), how would the organization conduct a full building evacuation?
  • In response to any emergency event, how would the organization provide command, control and coordination (e.g., Command Center, Incident Management Teams)?

Occupancy and Operation

The HRO understands that building occupancy is not the end of the process but rather the beginning of the next phase. Continued readiness and commitment to regular procedural improvements are ingrained in the culture. Key characteristics of HROs include deference to expertise, preoccupation with failure and a commitment to resilience. These principles drive the organization to continuously develop or expand existing routine programs to monitor the newly occupied space. Programs that address the Enviroment of Care typically include:

  • Safety and security, including operational security and infrastructure.
  • Hazardous materials protection and management, including response plans.
  • Medical equipment programs, including routine preventive actions and failure investigation protocols, help determine root causes, learn from errors and make necessary adjustments to prevent them.
  • Utilities, including management and contingency plans.
  • Fire safety programs, including response plans and training.
  • Life Safety Code Assessments to ensure continued compliance and appropriate building maintenance.
  • Emergency preparedness training, drills and exercises.


High reliability means sustainable, consistent excellence in quality and safety across all services provided. High Reliability Organizations are relentlessly aiming to protect what matters across their healthcare ecosystems. Jensen Hughes proudly partners with healthcare organizations, providing solutions to help them navigate these complex matters and achieve their goals. Learn more about how the Jensen Hughes Healthcare Team can assist your organization to be a High-Reliability Organization.

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