Managing the Unexpected
High Reliability develops an organization’s strengths through individual actions.
Shared attitudes fill the gap between organization and the individual to determine High Reliability.
Topic: Sustaining High Reliability:
|Dates: March 28-30, 2014
Location: Fort Worth, Texas, USA
|Sustaining High Reliability:
Reference HRO Conference to get the special rate(s)
Residence Inn Ft Worth Cultural District
Towne Place Suites Ft Worth Downtown
"How do organizations respond to ambiguous information?"
Saturday, 29 March 2014
Sunday, 30 March 2014
Plenary, morning: Christopher Hart, Vice Chairman, National Transportation Safety Board
Poster and Oral Presentations throughout the conference
This workshop is designed for those organizations where the executive level has decided to use HRO. Participants will discuss the circumstances of their organization, what worked and what did not work in real situations, and the implementation of HRO at the level of line staff, managers, and executives. Participants will reflect on their experiences with a panel of experts.
This workshop is for individuals who want to bring HRO to their own program, acting from within the organization and at their level of function. Participants will share success stories and problems as they specifically apply to the participants with assistance from change experts.
This workshop discusses how HRO relates to other safety and reliability methods and how it can benefit your organization. Designed for those new to the concept or newly beginning, experts will discuss the principles of HRO and how you can immediately begin using High Reliability methods in your organization.
This workshop is for those having familiarity with HRO that want to refine their approach. They may have had some setbacks or they now want to increase the value of HRO to make their organization stronger.
This workshop will discuss how simulation can be used to create HRO attitudes and refine problem-solving for uncertainty and under threat. It is designed to take simulation beyond training for tests and teamwork.
This workshop discusses the leadership methods used in HROs where the point of activity is distant from central or even outlying leadership. The goal of HRO leadership is leader-leader, how to make every member a leader who identifies problems and leads toward a solution.
This workshop will discuss how the nuclear power in the US has achieved its great strides in safety and also in reliably producing electricity with a decrease in time off-line. The relationship of Human Performance Improvement (HPI) in HRO will be discussed. Faculty are experienced US Navy nuclear officers.
This workshop will discuss how HROs applied to manufacturing in the trades. Manufacturing can benefit from HRO at both the level of the foreman and the line worker. In this arena, HRO is not very different from how it developed in U.S. Navy aircraft carrier operations.
Healthcare is under increasing pressure to improve patient safety while also improving performance through efficiency and effectiveness. HRO methods adapted from high-risk organizations can successfully lead to improvements in safety and reliability for healthcare. Challenges to implementation of HRO will also be discussed.
The safety of chemical processes is vital to a community. The majority of chemical incidents do not fall under environmental or occupation safety guidelines. HRO can contribute to increased chemical safety and the experiences of chemical process safety can assist other programs in their move toward HRO.
Communicating the value of operating as an HRO can be difficult. What is the value proposition of HRO for managers? HRO is more than a method to increase the company bottom line to increase competitiveness. Before codification of HRO practitioners used these principles to increase worker performance and strengthen their organization. Safety in high hazard environments came through good operations and good operations came through safety. This panel discussion will talk about how HRO provides a framework to help organizations by demonstrating positive ways to improve their bottom-line.
Panelists will present short case studies of HRO implementation or transformation with focus on what worked well, what didn’t work well, and words to the wise for practitioners. These are organizations that have reached HRO giving the opportunity for attendees to ask what HRO looks like and who we should look to.
Defining an operational definition of HRO practice (as opposed to theory or traits) is elusive. Organizations should describe their operational definition, and describe how implementation, progress, and sustainment are measured.
Numerous programs advance safety and reliability and appear to compete, conflict, or complement each other. This panel will compare the advantages of HRO to Six Sigma or Lean and ISO 9000 certification and will discuss how they operate under the umbrella of HRO. Also explored is how they can synergistically combine rather than oppose each other.
HRO is generally described for organizations with some discussion on interactions between organizations. Focus is on safety to the employees and community while reliably providing a product or service. In healthcare, patients are the source of information and the agents for treatment with a strong non-medical influence from experiences, family, friends, and marketing efforts of commercial products. Enactment can better describe the interactive collaboration between patient and healthcare professionals with Weick and Sutcliffe’s five principles making medical care operational. This panel will discuss how to bring these principles to the healthcare-patient interaction and to the patient and patient’s social contacts.
RAdm Thomas A. Mercer, USN (retired) requested academics from the University of California, Berkeley, to assist in the study of his ship and ways to increase the performance of his crew. Much of the focus on early HRO studies then focused on the high-risk flight deck with less emphasis on what went on below decks. RAdm Mercer believes that if you take care of the crew below the flight deck the flight deck will take care of itself. There are other approaches the US Navy uses in nuclear power and the US Marine Corps use as that will be discussed. Focus is on applicability of these approaches to civilian HRO operations.
Organizational structure is designed to conduct business in the most effective way. When the unexpected occurs as a dynamic situation the organization may have to rapidly re-organize for an effective and resilient response. The Incident Command System (ICS) can be a part of the organization's end state for the unexpected rather than a means to reach it. ICS works best when it is within the organization's structure and not created ad hoc during the unexpected event. Fire command systems create a complex organization on the fly with ICS and this can benefit business organizations.
HRO appears to uniquely benefit those organizations that routinely face the unexpected. This panel will explore whether the experience of calmer times leads to loss of HRO and how we can monitor the organization to maintain High Reliability Organizing. This session will discuss sensing that your program is drifting away from HRO, a qualitative, not quantitative, measure.
Discussion of using the pointy stick in leadership, that is, the pointy end vs. the blunt end of the stick, may, to put it bluntly, be missing the point. During WWII in the US industrial productivity in the United States increased through use of middle managers (Training Within Industry). This panel will discuss the role of the middle manager in creating HRO.
Deferring to subordinates, making things more complex than needs to be, and straying from the plan can all appear counterintuitive to managers, planners, and executives. In fact, HRO can appear to increase risk. Panelists will discuss ways to introduce HRO to those who have somewhat limited experience with successful actions in uncertainty or in the face of threat.
There is discussion in business ethics and the question whether a business can be a moral agent. Does High Reliability inherently contain ethics and, if so, is it as moral character, duties or rules, or from the consequences of actions? How would this apply to individuals within an HRO? Acting in an environment of uncertainty and threat, where decisions can have serious consequences, are there guidelines for ethical decision-making regarding paternalism, autonomy, and beneficence? This is a new area for us, and one that our panel will discuss with attendees. How do HROs and ethics combine?
Regulatory and accrediting agencies are well known to have familiarity with problems in an organization or industry. What is less often acknowledged is their knowledge of what works. This panel will discuss how these agencies begin the process of sharing in a way specific to the organization in need.
This panel of legal experts will discuss liability, tortes, rules, and regulations that are commonly presented as reasons to limit authority migration and can reduce the acceptance of HRO.
The purpose of this session is to provide all participants in this sequence a shared mental model of the challenges people face when trying to transform their organizations in order to provide them a focal point to discuss challenges they may be facing (or will be facing) in their organizations as they attempt to move toward high reliability. This group will use a prescriptive approach toward resistance in an organization.
Leadership in an HRO can seem distant in space and time. Events may or may not happen; the information necessary is never fully known. This panel will discuss what HRO leadership is and how to develop it in your organization.
This panel will discuss where resistance comes from and why it exists using a diagnostic approach. This session is organized to allow various HRO implementers to share resistance to change toward HRO in their organization with discussions on proven method on how to overcome these barriers. Potential forms of resistance could include why doesn’t HRO work; what is the inertia to change; what if it doesn’t work; what I am doing is working, so I don’t need anything else; marginalization of safety officers; and push back as a phase of enactment. This panel will use a descriptive approach to identify various sources of resistance.
We can view HRO as self-organization at the local level from short feedback loops and nonlinear interactions with the environment. Much like the rain drop beading up on the hood of a car. Too big and it collapses from gravity, too small and it does not aggregate from surface tension. So, HRO is a self-organizing response to an environmental disturbance that, itself, is self-organizing. People respond to local effects in a way that makes sense to them to create innovation and work-arounds. When congruent with reliability and safety processes this can increase productivity while ensuring safety. When acted poorly it creates latent dangers. This panel will discuss self-organizing reliability.
Our mental models (our perceptions of how the world around us operates) have a powerful influence over our behaviors. The problem is our mental models are seldom visible to anyone in our organization. As such one wonders how can we move our organization to become highly reliability when no one is operating with the same operating model or understanding of the challenges or solutions. This session focuses on how to understanding the power and challenges of mental models with methods to make them openly visible to create collective sense making.
Sometimes our perception of reality, after we take actions to improve our organizations, are so flawed that we misread our success. We may think our efforts are outstanding successes when those involved in the changes see them as dismal failures. This session discusses the challenges of sense making when accurate feedback is missing.
High-risk decisions made by organizations are often made based on how work was planned. In reality, the actual risk comes from how work was actually performed. One of the most powerful tools for managers is to recognize potentially faulty high-risk decisions by systematically comparing how work was planned versus how it was actually executed. This session will introduce techniques to make these comparisons and what changes to make when the gaps are recognized.
This session offers the opportunity for organizations that have attempted to use HRO techniques to share positive and measurable examples of what they did and how they demonstrate successes. Here, HRO is an end state and this panel will discuss what do I do to get there and can the organization save money at the same time?
Many organizations use a variety of techniques to implement HRO. These steps depend on the type of industry the process is being undertaken and upon the culture of the country in which the organization is within. This session provides an opportunity for those who have proven methods to implement HRO to share their lessons learned. This panel will discuss activities taken in the process of moving to toward HRO.
Simulations provide a unique and very powerful learning HRO learning tool by providing the participant an opportunity to play the role of a manager or an HRO change agent and experience first-hand, in a non-threatening environment, the impact of their decisions on the organization or the positive impact HRO improvements will make. This session(s) provides the opportunity to share various methods of simulations to provide an interactive learning environment. (This has the potential to being broken out into two sessions with the same topic area to accommodate the many simulation topics).
The concept of HRO cannot be an add-on to existing programs or a program in and among itself. Rather it must be an integral part of how work is done. As such, this panel will discuss how we can integrate the principles of high reliability into everyday operating paradigm to become more successful.