ABSTRACT
Most healthcare processes are more critically dependent on components that cannot be fundamentally redesigned: human beings. Most healthcare staff will readily acknowledge that ‘workplace culture’ is a critical determinant of how safe our patients are–even if they cannot describe with any great rigor or precision what culture is, the mechanism of its impact on safety, or how culture can be changed. In our own work we return repeatedly to the concept of the ‘high reliability organisation’, an idea that is familiar to some in healthcare but which has yet to fully penetrate the thinking of health service leaders. Always a simplification, nineteenth-or twentieth-century image holds even less well for modern knowledge-based organisations, especially healthcare organisations, but it nonetheless has a tenacious hold on our imaginations. Understandably, the programme generated huge excitement and, ultimately, was successfully transplanted into other organisations in the same state, across the United States, and beyond.
