EMS & High-Reliability Organizing by Daved van Stralen & Thomas A. Mercer

Systems today, particularly those like EMS that are tightly linked between human actions and technology, have become complex to the level that “accidents” are not only predictable, but they can be expected. Charles Perrow described this as Normal Accident Theory after he studied the Three Mile Island nuclear power plant incident.

A few years later, academics from the University of California, Berkeley were studying the notion that “accidents” in high-risk environments can be considered “normal.” They came across the aircraft carrier USS Carl Vinson. Thomas A. Mercer, who was the carrier’s captain, invited the Berkeley researchers to study his crew for methods to improve their performance.

According to a personal communication by Karlene Roberts, PhD, the Berkeley team found an efficient team of operators who solved problems before they became significant; the team was unable to identify areas requiring significant improvement. Therefore, they codified the methods as indicative of a high-reliability organization (HRO) and found an exception to the idea that it was normal for consequential errors to occur in high-risk environments. From their studies, they codified the ship as an HRO due to its organization.