Iranian Journal of Public Health 2018. 47(1):77-85.

Assessment of High Reliability Organizations Model in Farabi Eye Hospital, Tehran, Iran
Seyed Mohammad Hadi MOUSAVI, Mahmoud JABBARVAND BEHROUZ, Hojjat ZERATI, Hossein DARGAHI, Akram ASADOLLAHI, Seyed Ahmad MOUSAVI, Elham ASHRAFI, Abolfazl ALIYARI



Background: A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015- 2016.

Methods: In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman’s correlation coefficient and Mann-Whitney test using the SPSS software version 19.

Results: Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital.

Conclusion: Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.



High reliability organizations model, Knowledge, Staffs and managers, Iran

Full Text:



Vogus TJ, Sutcliffe KM (2007). The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Med Care, 45 (10): 997-1002.

Baker DP, Day R, Salas E (2006). Teamwork as an essential component of high-reliability organizations. Health Serv Res, 41: 1576-1598.

Kahn L, Corrigan J, Donaldson M (1999). To Err is human: building a safer health system. Institute of medicine. National Academy Press, Washington DC, pp.: 66-72.

Leonard MS, Frankel A (2004). Focusing on high reliability in achieving safe and reliable healthcare: strategies and solutions. Health Administration Press, Chicago, pp.: 18-20.

Weick KE (2002). The reduction of medical errors through mindful interdependence: what do we know, what do we do? Jossey-Bass, San Francisco, pp.: 177-199.

Rochlin GI, La Porte TR, Roberts KH (1987). The self-designing high reliability organizations; aircraft carrier fight operation at sea. Naval War College Review, 1 (1): 76-90.

Roberts KH, Rousseau DM (1989). Research in nearly free, high-reliability organizations: having the bubble. IEEE Transactions on Engineering Management, 36 (2): 132-139.

Weick KE, Roberts KH (1993). Collective mind in organizations: heedful interrelating on flight decks. Administrative Science Quarterly, 38 (3): 357-381.

Roe E, Schulman PR (2008). High reliability management: operating on the edge. Stanford University Press, Pala Alto, CA, pp.: 36-45.

Schulman P (2004). General attributes of safe organizations. Qual Saf Health Care, 13: ii39-ii44.

Rochlin GI (1993). Defining high reliability organizations in practice: a taxonomic prologue. In: New challenges to understanding organizations. Eds, Raberts HH. Macmillan Inc, New York, pp.: 11-32.

Weick KE, Kathleen M, Suthcliffe HM (2001). Managing the unexpected assuring high performance in age complexity. Jossey-BASS, San Francisco, CA, pp.: 10-17.

Weick KE, Sutcliffe HM, Obstfeld D (1999). Organizing for high reliability: processes of collective mindfullness. In: Resesrch in organizational behavior. Eds, Staw BM, Cummings LL. JAI Press Inc, Greenwich, CT, pp.: 81-123.

Fredrickson GH, Laporte TR (2002). Airport security, high reliability, and the problem of rationality. Public Administration Review, 62: 33-43.

Babb J, Ammons R (1996). BOP (Bureau of Prisons) inmate transport: a high reliability organization. Corrections Today, 58 (4): 108-110.

Monograph on the internet. James M (2008). Becoming a high reliability organization. Center for Health System Excellence.

Vogus TJ, Sutcliffe KM (2007). The safety organizing scale: development and validation of a behavioral measure of safety culture in hospital nursing units. Med Care, 45 (1): 46-54.

Singer SJ, Gaba DM, Geppert JJ, Sinalko AD, Howard SK, Park KC (2003). The culture of safety in California hospitals. Qual Saf Health Care, 12 (2): 112-118.

Dargahi H (2013). Quantum leadership: the implication for Iranian nursing leaders. Acta Med Iran, 51 (6): 411-417.

Reason J (1990). Human error. Cambridge University Press, New York, pp.: 33-40.

Dixon NM, Shofer M (2006). Struggling to invent high reliability organizations in health care setting: insights from the field. Health Serv Res, 41 (4-2): 1618-1632.

Pronovost PJ, Berenholtz SM, Goeshel CA et al (2006). Creating high reliability in health care organizations. Health Serv Res, 41 (4-2): 1618-1632.

Leape LL (1994). Error in medicine. JAMA, 272 (23): 1851–1857.

Helmreich RL, Merritt AC, Willhelm JA (1999). The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol, 9 (1): 19-32.

Wilson KA, Priest HA, Salas E, Burke CS (2005). Can training for safe practices reduce the risk of organizational liability? In: Handbook of human factors in litigation. Eds, Noy YI, Karwowsky W. CRC Press, Barcelona, pp. 61-63.

Weick KE, Sutcliffe KM, Obstfeld D (2008). Crisis management. Sage Publication Inc, Thousands Oak, CA, pp. 31-36.

Carthey J, De Leval MR, Reason J (2001). Instututional resilience in healthcare systems. Qual Health Care, 10 (1): 29-32.

Mousavi SMH, Dargahi H, Mohammadi S (2016). A study of the readiness of hospitals for implementation of high reliability organizations model in Tehran University of Medical Sciences. Acta Med Iran, 54 (10): 667-677.

Tamuz M, Harrison MI (2006). Improving patient safety in hospitals: contributions of high reliability theory and normal accident theory. Health Serv Res, 41 (4-2): 1654-76.

Gaba DM, Singer SJ, Sinaiko AD, Bowen JD, Ciavarelli AP (2003). Differences in safety climate between hospital personnel and naval aviators. Hum Factors, 45 (2): 173- 185.

Monograph on the internet. Anonymous (2011). National patient safety goals. The Joint Commission.

Monograph on the internet. Anonymous (2011). What is accreditation? The Joint Commission.

Mousavi SMH, Zeraati H, Jabbarvand M, Mokhtare H, Assadollahi A, Dargahi H (2016). Assessment of patient safety for quality improvement based on Joint Commission International Accreditation standards in Farabi eye hospital of Tehran University of Medical Sciences. Journal of Patient Safety & Quality Improvement, 4 (2): 351-357.

Monograph on the internet. Anonymous (2011). Facts about the Joint Commission Center for transforming healthcare. The Joint Commission.

Chassin MR, Loeb JM (2011). The ongoing quality improvement journey: next stop, high reliability. Health Aff (Millwood), 30 (4): 559-568.

Anonymous (2008). Behaviors that undermine a culture of safety. Sentinel Event Alert, 9; (40): 1-3.

McGinnis L (2011). Creating high reliability: a new approach for patient safety. AORN J, 94 (3): 219-222.

Dargahi H, Tehrani GS (2013). Clinical laboratories as high reliability organizations: is it possible? Journal of Laboratory & Diagnosis, 5 (21): 11-18.

Mousavi SMH, Jabbarvand M, Zeraati H et al (2016). Training courses and staff knowledge for implementation of high reliability organizations model in Farabi eye hospital, Tehran, Iran. IRCMJ, 18 (12); e41043.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.