• Innovation in Action

Jan 5, 2022

Accountability, Trust, Respect are Key Traits in HROs


In high reliability organizations (HRO), individual team members hold themselves, and others, accountable for their actions and behaviors. At the foundation of these teams lies a sense of trust and respect, that is built and cultivated over time and through open and candid communication. They recognize a “deference to expertise,” and the contributions of all team members, regardless of seniority or stature.

Unlike environments that have static performance teams with consistent members, like sports or musical groups, healthcare teams frequently change or are created in an instant. For example, a team member working in the ICU takes a patient to radiology for a CT scan. This event creates a new team, which may not have a shared communication pattern or understanding of the plan to care for this patient. However, these team members are now depending on each other to provide care to this patient and to react quickly if the patient’s status changes. How do you create synergy within a team that has not had the advantages of working together enough to develop a pattern of performance? You have to rely on teaming, which is “teamwork on the fly.”

Effective teaming depends on teamwork skills such as clarifying each members roles, coordinating activities, and establishing trust. Team members must be able to communicate clearly, frequently asking questions and verifying information. Organizations can support these efforts by establishing standard methods of communication, and by growing a safety culture that makes team members feel that it is safe to speak up when they have questions, need clarification, or recognize that something is not working as planned.

Standard communication formats exist that your organization may adopt to support teaming. They have similar concepts for sharing clear and concise information, so the most important factor for success is to select methods that are standardized and routinely utilized in your organization. Table 1 lists tools promoted by TeamSTEPPS.

SBAR Situation, Background, Assessment, Recommendations: This technique is used for communicating critical information that requires immediate attention and action concerning a patient’s condition.
Call-Out Strategy used to communicate important or critical information.

  • Informs all team members simultaneously during emergent situations
  • Helps team members anticipate next steps.
  • Important to direct responsibility to a specific individual responsible for carrying out the task.
Check-Back Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended.
“I PASS THE BATON” Handoff tool designed to enhance information exchanged during transitions in care.

Table 1: Communication Tools

Edmondson, A.C. (2012). Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. Jossey-Bass.

TeamSTEPPS Fundamentals Course: Module 3. Communication (n.d.)