What is HRO?
When I first began learning about HRO I read that it was a description of organizations that operated in high intensity, high-risk environments but had fewer than expected serious incidents. Karlene Roberts, from the University of California, Berkeley, told me that our PICU was operating as an HRO. She heard about our program from Pete Sarna, Chief of Public Safety for Alameda County Parks and Recreation, who came across me from comments I made on emergency decision-making at a California state EMS conference. He was talking to an EMS physician who attended this conference and heard about my use of John Boyd's OODA Loop to teach pediatric residents how to make decisions in emergencies.
This is a bit circuitous to get to the definition but it helps to understand that those of us who grew up in an HRO before Dr. Roberts codified it did not necessarily learn the program for purposes of safety or reliability. We learned it as a means of doing our job. If you were hurt you could not do your job, and if you did your job well you were less likely to be hurt.
The definition given above is the academic definition and whether it matters or is important to a line worker facing danger is probably not so important. The definition, to me, is more of an epiphenomenon of the work we do at the interface with the problem or environment we work in. This blog will focus on the small bits and pieces that will come together to form an HRO, or whatever the academic researchers will call it.
When I was faced with a situation I did not want to make a mistake so I constantly watched to see if my efforts were moving in the right direction. If the mistake hurt my patient, my partner, or me it was a safety issue. If the mistake damagd Fire Department issued equipment it was a quality problem. If the mistake used up resources or tied my unit up for an extended period of time it was a productivity issue. I did not focus on safety, quality, or productivity. I focused on identifying my mistakes and correcting them as soon as possible. Since I was not perfect at this (it is hard to identify your own mistake as it seems so right at the time or you would not have done it), I relied on my partner to watch for my mistakes just as I watched for his.
For us, the academics can focus on the definitions of reliability and safety and they can define all the concepts that we use. I will focus in this blog on error identification and correction, modulating emotions in emergencies, making decisions, forming a team, and leading people. Defining terms is important and I will make operational definitions that are clear and concise with each word having one meaning.
HRO, to me, is a way of acting in uncertainty or when faced with threat and under time pressure. HRO will not prevent bad outcomes but will help you work through them. In fact, that may be what HRO is, the ability to perform in the confusion of uncertainty and threat when other people have lost their way.