Risk management has become a key ingredient for businesses all over the world. High Reliability Organizations (HRO) has distinguished themselves as experts in this area. By continuously focusing on improving their ability to manage risks they’ve been able to successfully avoid catastrophes in environments where normal accidents can be expected due to complexity and risk factors.The aim of the thesis is to improve the risk management at Apotekens Service by applying theories from HRO and safety culture. In July 2009, following the re-regulation of the Swedish pharmacy market, Apotekens Service AB was appointed national pharmacy infrastructure supplier for the Swedish health care system. The market's direction and scope gives rise to a complex socio- technical environment that places high demands on the company's risk handling activities. By mapping the principles behind the success of HROs against methods used today, the thesis develops a foundation for how companies like Apotekens Service can manage risk efficiently.The analysis shows that there are great opportunities for Apotekens Service to apply theories of HRO and safety culture to improve their risk management.The company already has a positive safety culture, which is a prerequisite for maintaining safety over time. By mapping out the organization’s internal system dependencies, perform a threat analysis and develop an effective information management system Apotekens Service will improve the internal transparency whilst strengthening the possibilities for learning and effective communication. Finally, the thesis presents three risk management tools for assessing risk and reviewing the company’s ongoing work in the area.

Hospital-acquired conditions cause harm to patients and increase mortality. In addition to lowering the quality of patient care, hospital-acquired conditions also negatively affect financial performance, which makes them a business problem for hospital administrators. The purpose of this single case study, which was grounded in the theory of high reliability, was to explore strategies used to reduce the number of hospital-acquired conditions. The sample consisted of 13 senior leaders of a large academic medical center in the southeastern United States, who shared successful strategies used to reduce hospital-acquired conditions. Data collection took place through semistructured interviews and a review of plans and reports that showed rates of hospital-acquired conditions from 2014 to 2017. Data analysis involved using Yin's 5-step process as well as coding interview text and data from documents and then grouping related words to develop themes. Themes that emerged from this study included leadership style, communication practices, and trust. A key finding was the importance of positive and trusting leadership behaviors by senior leaders planning to reduce hospital-acquired conditions. Another key finding was the confirmation that hospital administrators can and should prioritize quality and financial improvement simultaneously. The implications of this study for positive social change include the potential to reduce health care costs and save patients' lives by reducing the number of hospital-acquired conditions.

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Emergency response team (ERT) member characteristics that contribute to High Reliability performance during patient care resuscitation events or other Critical Incident Management Situations are poorly understood. Findings from this study describe individual characteristics that experienced interprofessional ERT members perceive as contributing to High Reliability performance within the critical incident management context. This study supports the need for interprofessional research about emergency response teams’ High Reliability in hospital-based settings. ERT High Reliability, or “better than expected” team performance has been linked to overall patient care and safety. The purpose of this study was to identify and describe individual team member characteristics that contribute to High Reliability performance of ERT members and the overall emergency response team in a naturalistic setting during Critical Incident Management Situations. Using a qualitative descriptive design, data collection included participant observations, field notes, and interviews. Narrative data were audio-taped, transcribed and coded using Ethnograph v6©. Data content were analyzed thematically using inductive interpretive methods. Two major domains derived from the data were Self-Regulation and Whole-Team Regulation. The overarching theme, Orchestrating High Reliability at the Edge of Chaos, encompassed characteristics contributing to High Reliability performance of the ERT during Critical Incident Management Situations.

La fréquence et la sévérité des feux de forêt de grande ampleur ont augmenté dans les vingt dernières années, par la conjonction de trois tendances lourdes : le réchauffement climatique, l’extension des interfaces périurbaines et l’augmentation de la biomasse. Par conséquent, la fiabilisation des opérations de lutte, et en particulier des équipes de commandement, devient un enjeu important. Mais les opérations de secours constituent surtout une fenêtre particulièrement intéressante sur le fait organisationnel en général et les processus de construction de sens en particulier. En effet, les pompiers sont confrontés à des exigences organisationnelles en conflit : stabiliser le sens des situations pour assurer l’efficacité de l’action collective (processus de contrôle), et le réévaluer en permanence pour détecter et s’adapter aux évolutions inattendues (processus d’écoute). Le contrôle cherche à fiabiliser les apprentissages, capitalise les succès, ignore le bruit, simplifie, privilégie l’anticipation, et oriente l’attention sur les objectifs de l’action et sur la structure. L’écoute cherche à accroitre la validité des apprentissages, valorise l’improvisation, invente, détecte les signaux faibles, complexifie, rebondit, et oriente l’attention sur les conséquences de l’action et sur les relations interpersonnelles.L’hypothèse centrale de cette recherche est que la gestion de ces exigences contradictoires est une source majeure de haute fiabilité. Son design se base sur la comparaison de deux territoires (l’Ouest américain et le sud de la France), et combine plusieurs méthodes : l’observation directe des opérations de secours, l’observation des sessions d’entrainement, et des formations, ainsi qu’une expérimentation sur la plateforme de simulation de la Sécurité Civile française / The frequency and impact of large wildland fires have been increasing for the past 20 years, due to the conjunction of three long term trends: global warming, growing wildland-urban interface and increase in biomass. As a result, enhancing organizational reliability in Incident Management Teams is becoming increasingly important. Examining how firefighters face large disasters is also relevant for organization studies because these situations offer a perspective on organizing and sensemaking. Indeed, firefighters are under conflicting organizational requirements: stabilizing the sense of situations for effective collective action (control processes) and reassessing situations to detect and adapt to unexpected changes (mindful processes). Control focuses on lessons learned, capitalizes on success, ignores noise, simplifies, values anticipation and direct attention on plans and strategies. Mindfulness focuses on improvising, detects weak signals, is reluctant to simplify, values resilience and interpersonal relationships.The central hypothesis of this research is that the successful management of these opposite requirements is an important source of operational reliability. The research is based on a comparison between two territories (the American West and Southern France) and combines several methods: direct observation of firefighting operations, direct observation of Incident Management Teams trainings, the analysis of available archival data, as well as controlled experiments on a France’s Civil Protection simulation training platform

There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive. The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization. This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set. The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.

Specialised policing of critical incidents has previously been underexplored within scholarly research. Simultaneously, this type of policing has been recognised as a highly complex endeavour which hinges on an organisationalability to make sense of uncertainty and external contingencies. To build knowledge on the subject of specialised policing, the present thesis aims to explore processes of sensemaking and organising in the work context of specialised police units dedicated to the policing of high risk incidents. Two research questions have guided the thesis project viz.: 1) what ascribed meanings are coupled to specialised police unit work practice and; 2) how can organising of specialised police units be enacted in a reliable manner. These questions are empirically addressed through four part-studies: Study A amounts to a contextual literature study of previous research on specialised police units and aims at conceptual development of anomenclature describing police specialisation as a professional context. Study B in the thesis examines symbolic meanings connected to specialised police units and how such meanings relate to constructions of occupational identity of police officers working in a specialised police unit. With these studies as a contextual frame, study C within the thesis examines how leadership, management and ICT system within a specialised police unitimpacts organisational reliability and sensemaking during incident management. Finally, study D examines organisational reliability on an interpersonal level during incident management as it entails a study of collaboration between police practitioners conducting an intervention. The thesis employs a mainly ideographic and close practice approach to researchas the empirical examinations are focused upon one specific specialised police unit, namely the Swedish police’s National Counter-Terrorist Unit (NI). Using data collected through interviews, observations and archival sources, the thesis aims to contribute both to organisational developmentand to knowledge development within the scholarly community. In overview, the results of the thesis indicate that specialised policing on a level of ascribed meaning tend to be represented as exceptional, sensational and surrounded by inferences of elitism, machismo and violence. In extent, such representations inform serving police officers occupational identity workeither by spurring identification or dis-identification with prevailing accounts of meaning. On a level of organising, resilient policing of high risk incidents is shown to be dependent on an ability to favour flexibility, both through the organisational frameworks that frames incident management and in interpersonal enactment during task execution. This conclusion challenges day-to-day conceptualisation of specialised police units’ work practice as instrumental applications of coercion.

<p>There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive.</p><p>The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization.</p><p>This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set.</p><p>The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.</p>

Bakgrund: Uppsatsen tar upp problematiken kring att organisera arbetstid inom räddningstjänst. Grundförutsättningarna är att räddningstjänst är en High Reliability Organisation (HRO) och att det påverkar organisationen. I och med New Public Management (NPM) framfart och den ekonomiska situationen i världen har räddningstjänsten fått ett ökat krav på kostnadsbesparingar och resursutnyttjande. Då personalkostnader står för en stor del av räddningstjänstens kostnader kan förändringar av brandmännens arbetstid och skiftgång vara ett logiskt steg, något som skett i Greater Manchester Fire and Rescue Service (GMFRS). Syfte: Syftet med uppsatsen är ett ge ett teoretiskt bidrag till hur NPM influerade reformer påverkar en HRO. För att göra detta frågar vi oss vad de olika skiftformerna får för konsekvenser för de anställda och organisationen. Metod: Uppsatsen har en kvalitativ forskningsansats vid studerandet av fallorganisationen Greater Manchester Fire and Rescue Service och Storstockholms Brandförsvar. Data har samlats in främst genom intervjuer men vi har även använt oss av kompletterande observationer och dokumentsstudier. Den analysmetod vi valt är tematisering då denna underlättar vår analys genom att empirin bryts ner och kategoriseras. Resultat: Studiens resultat identifierar olika faktorer som påverkar organisationens medvetenhet samt arbetsmiljö. Det förs en diskussion huruvida dessa faktorer bidrar till en förstärkning eller en försvagning samt att mönster mellan påverkan på medvetenheten och arbetsmiljön undersöks.

National and international crises in the early 21st Century, whether natural, technological or man-made, emphasize the need for highly reliable organizations (HROs) to conduct emergency response in a relatively error-free way. Urban search and rescue units provide a pivotal intermittent role in these high-risk environments. Traditional HRO research focuses on a concept known as "collective mind" -- heedful interactions of responders that accomplish reliability. Rather than focusing on collective mind, this study uses a practice-based communication approach to examine the material interplay of bodies, objects, and sites using ethnography and grounded theory. In-depth interviews, participant observations, and organizational documents were coded and contrasted to find patterns in material interplay. More specifically, this study examines how these material features interact to orchestrate reliable practices through ecological coherence, a bonding of multiple forces to construct meaning and improvisation. The study has implication for HRO theory through focusing on the role of the body rather than emphasizing cognitive judgment in collective action. Collective body shifts the discussion of mindful processes to embodied practices and offers insights into the ways responders enact safety and perform responses in dynamic, high-risk environments.