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.

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.

Thesis advisor: Judith Vessey / Purpose: The purpose of this study was to explore the relationships between psychological safety, perception of working in a high reliability organization (HRO) and safety event reporting intentions among pediatric nurses working in acute care. Background: The quality and safety of patient care is dependent upon nurses to report safety events and near-misses in order to address systems’ issues and identify improvement opportunities. To encourage feedback and promote reporting, many health care organizations have adopted the high reliability framework and strategies to promote team psychological safety. A dearth of literature exists on how the pediatric nurse perceives their workplace. This study addressed this gap by measuring the pediatric nurse’s level of psychological safety, perception of whether or not they work in an HRO and their safety event reporting intentions. Methods: Using nonprobability convenience sampling, data were collected from pediatric nurses (N=244) during a one-time, anonymous, 10-minute web-based survey. The survey was distributed to members of the Society of Pediatric Nurses (SPN) and by members of the National Pediatric Nurse Scientist Collaborative (NPNSC) to their respective constituent groups. The online survey comprised of four sections: a demographic form, the Safety Organizing Scale (SOS), the Team Psychological Safety Scale, and the Intention to Report Safety Events Scale. A two-part statistical model was fit using logistic regression and linear regression. Results: Psychological safety was found to have a positive and statistically significant relationship with Intention to Report Safety Events Scores (p<0.01; β=0.274). The findings also revealed that when all other variables were excluded from the statistical model, a positive and statistically significant relationship between HRO perception and safety event reporting intentions (p=0.034) existed. The logistic regression model revealed that the odds of a pediatric nurse achieving the highest safety reporting intention score of 7 increased by a factor of 0.3 with each additional year of practice. Conclusions: The findings demonstrated that a nurse’s perception of whether they work in a high reliability setting and how psychologically safe they feel profoundly effects their attitude towards safety event reporting. This work advances the state of the science by demonstrating how workplace culture, and specifically psychological safety and the HRO framework, influences reporting intentions. The information gained from this study will be useful to organizational leaders and professional groups who seek to improve patient safety reporting systems, communication strategies and existing workplace cultures. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Svensk militär verksamhet organiseras och leds i ett normalläge, för att snabbt kunna möta och hantera en hastigt uppkommen påfrestning. På motsvarande sätt finns annan verksamhet i samhället som verkar under liknande förutsättningar. Vad kännetecknar en militär organisation som skall hantera påfrestningar med hög operativ effekt, och vad utmärker metoden för att leda verksamheten vid påfrestning? Vilka utmaningar och lösningar kan identifieras? I syfte att vidga perspektiven gjordes en jämförelse i kontrasterande syfte mellan ett militärt förband och ett akutsjukhus. Genom en induktivt driven ansats och kvalitativ metod, genomfördes sju semistrukturerade djupintervjuer vid Luftstridsskolan i Uppsala och Lokal katastrofledning vid Gävle sjukhus. Likheterna mellan de undersökta enheterna avseende organisation och ledningsmetod samt utmaningar och lösningar kopplade till detta var stor. Med utgångspunkt i begreppen High Reliability Organizations och Ambidextrous Organizations diskuteras resultaten, som ger förutsättningar att utveckla organisation och ledningsmetod främst vid författarnas förband Luftstridsskolan. För att nå detta är författarnas konkreta rekommendationer, med stöd i empiri och litteratur, bl.a. att i högre utsträckning nyttja tvärfunktionellt sammansatta ledningsgrupper för att hantera påfrestningar eller komplexa planeringsuppgifter och därigenom minska stuprörstänkande, att sträva mot förbättrad gemensam lägesbild vid flottiljstab och att avkräva lojalitet mot beslutad organisation och ledningsmetod. Detta bedöms leda till ökad operativ effekt vid förbandet. / Swedish armed forces are normally organized for education and training on a daily basis, for the purpose of rapidly being able to deal with sudden events or strains. What signifies a military organization and command dealing with these kinds of strains whilst maintaining a high level of operational effect? What challenges do they face and what kinds of solutions are available? In order to expand the perspective a comparison was made with a military unit and an emergency hospital. This study was carried out withan inductive and qualitative method, and seven semi-structured interviews were conducted. By the perspectives of High Reliability Organizations and Ambidextrous Organizations, the results are discussed. The resemblances between the two researched units are surprisingly striking in the investigated areas of interest. In order to improve organization and command at the researched military unit, the authors recommend the following actions: the use of joint functions command groups to a greater extent in order to enhance the ability to handle strains and sudden events, to strive for a greater level of situational awareness on all levels in the organization and the demand for loyalty to organization and structure of management decided by the commander. These actions are deemed to increase the level of operational effect at the unit.

As water systems are critical infrastructures, their continuous service is essential for maintaining vital functions of society. During the past decades, a number of severe global challenges have put increasing pressure on the water systems, threatening the quality and availability of water. Digitalization is expected to play a fundamental role in managing these challenges, making the digital transformation of the water industry an imperative rather than a choice for water utility providers. However, the implementation of digital solutions also entails a number of challenges, risks and vulnerabilities to water systems. As such, water utility providers are faced with increased complexity and uncertainty, where the safety and security of the system is at stake. This thesis addresses the potential implications of a digital transformation of the water industry by exploring how digitalization affects the Swedish water sector from a safety and security perspective. By doing so, the thesis aims to enhance the understanding of how Swedish water utility providers can manage its ongoing digital transformation. The thesis consists of a qualitative research study where interviews with 16 representatives from the Swedish water industry contributed with a broad perception of the implications of the digital transformation. Theory on high reliability organizations and resilience was applied to obtain a deeper understanding of what the potential safety and security implications may entail for Swedish water utilities in managing and reaping the benefits of their digital transformation. The study finds that representatives from the Swedish water sector mainly view benefits related to the efficiency of their operations from their ongoing digital transformation, while the mentioned drawbacks are generally related to their organizational abilities in managing the emerging risks and increased level of complexity. With increasing digitalization, Swedish water utilities coincide with the high reliability organization theory to a higher extent, which emphasizes the increasing importance of employing bothtechnical reliability and organizational resilience practices. This thesis concludes that technical reliability has historically been well-managed and prioritized by utilities, whilst organizational resilience has become an increasingly important aspect to focus on with increasing digitalization. Hence, practices of organizational resilience, such as incorporating clear strategies, integrating work between divisions and increasing follow-up from disturbances, should be employed on a wider scale among water utilities. / Då vattensystem är kritisk infrastruktur är deras kontinuerliga funktion avgörande för att upprätthålla vitala funktioner i samhället. Under de senaste decennierna har ett antal allvarliga globala utmaningar ökat trycket på vattensystemen, vilket hotar vattnets kvalitet och tillgänglighet. Digitalisering anses vara avgörande för att hantera dessa utmaningar, vilket gör digitalisering av vattenindustrin till en nödvändighet snarare än ett val för VA-bolag. Att implementera digitala lösningar medför emellertid också ett antal utmaningar, risker och sårbarheter för vattensystem. VA-bolagen står således inför en ökad komplexitet och osäkerhet där systemsäkerheten står på spel. Denna uppsats behandlar de potentiella implikationer som kan uppstå av en digital transformation av vattenindustrin genom att undersöka hur digitalisering påverkar den svenska VA-sektorn ur ett säkerhetsperspektiv. Genom detta syftar uppsatsen till att öka förståelsen för hur svenska VA-bolag kan hantera sin pågående digitalisering. En kvalitativ forskningsstudie har genomförts där intervjuer med 16 representanter från den svenska VA-sektorn bidrog med en bred uppfattning om digitaliseringens implikationer för den svenska VA-sektorn. Teori om high reliability organizations och resiliens användes för att fördjupa förståelsen för vad de potentiella säkerhetsimplikationerna kan innebära för svenska VAbolag, både för hantering av riskerna och för att ta till vara på fördelarna med den digitala transformationen. Studien visar att representanter från den svenska VA-sektorn, i deras pågående digitalisering, huvudsakligen ser fördelar relaterade till effektiviteten i vattenproduktionen, medan de nämnda nackdelarna i allmänhet är relaterade till deras egna förmågor att hantera de framväxande riskerna och den ökade komplexiteten. Med ökad digitalisering kan svenska VA-bolag i högre utsträckning beskrivas med teori kring high reliability organizations, vilket medför en ökad vikt av att arbeta med både teknisk tillförlitlighet och organisatorisk resiliens. Teknisk tillförlitlighet har historiskt hanterats väl och prioriterats av VA-bolag, medan organisatorisk resiliens har blivit allt viktigare att fokusera på med ökad digitalisering. Därför drar denna uppsats slutsatsen att arbete med organisatorisk resiliens, såsom att införa tydliga strategier, integrera arbetet mellan avdelningar och öka uppföljningsarbetet efter störningar, bör utföras i större skala bland VA-bolag.

Heuristic estimates of probabilities may be an obstacle to decision making within High Reliability Organizations. Accident reports have found that two from each other separate phenomenon, Blame Culture and Type 1 processing constitutes a particularily serious threat to decision making. The present study (N = 70) investigated if a perceived risk of negative feedback and cognitive load would lead to more heuristic estimates on the Conjunction Fallacy. Three experiment conditions were included in the study: Negative feedback, cognitive load and control. The results were non-significant for both negative feedback and cognitive load. Furthermore, the estimated negative affect was higher when violations to the Conjunction Rule was made. Previous studies showing that high scores on the Cognitive Reflection Test (CRT) indicate less sensitivity to conjunction fallacies, were replicated. The present study concluded that the CRT may be a strong predictor of the Conjunction Fallacy.

No description available.

Practical drift is defined as the unintentional adaptation of routine behaviors from written procedure. The occurrence of practical drift can result in catastrophic disaster in high-reliability organizations (e.g. the military, emergency medicine, space exploration). Given the lack of empirical research on practical drift, this research sought to develop a better understanding by investigating ways to assess and stop the process in high-reliability organizations. An introductory literature review was conducted to investigate the variables that play a role in the occurrence of practical drift in teams. Research was guided by the input-throughput-output model of team adaptation posed by Burke, Stagl, Salas, Pierce, and Kendall (2006). It demonstrates relationships supported by the results of the literature review and the Burke and colleagues (2006) model denoting potential indicators of practical drift in teams. Research centralized on the core processes and emergent states of the adaptive cycle; namely, shared mental models, team situation awareness, and coordination. The resulting model shows the relationship of procedure—practice coupling demands misfit and maladaptive violations of procedure being mediated by shared mental models, team situation awareness, and coordination. Shared mental models also lead to team situation awareness, and both depict a mutual, positive relationship with coordination. The cycle restarts when an error caused by maladaptive violations of procedure creates a greater misfit between procedural demands and practical demands. This movement toward a theory of practical drift in teams provides a conceptual framework and testable propositions for future research to build from, giving practical avenues to predict and prevent accidents resulting from drift in high-reliability organizations. Suggestions for future research are also discussed, including possible directions to explore. By examining the relationships reflected in the new model, steps can be taken to counteract organizational failures in the process of practical drift in teams.

No description available.