In response to an ongoing patient safety dilemma within healthcare organizations, many healthcare organizations have shifted their focus towards high reliability science. Research in this field of study has focused on high risk industries, such as aviation, nuclear power, and aircraft carriers, which have obtained low rates of error despite operating in a complex work environment where errors would normally occur. Experts studying these high reliability organizations suggests that highly reliable performance can be achieved by mindfully organizing to achieve collective mindfulness—a collective behavioral capability to discover and correct preventable errors and adapt to unexpected events. Their theory suggests there are five processes (or principles) required to produce a collective state of such mindfulness: Preoccupation with Failure, Reluctance to Simplify, Sensitivity to Operations, Commitment to Resilience, and Deference to Expertise. These socio-cognitive processes result in the participants mindfully looking for errors, discussing ways to learn from errors (updating), and drawing upon and deferring to each other’s expertise when needed.

While the theory and principles seem relatively straightforward, it is often hard to implement them in healthcare organizations. In fact, there are few studies that have shown this way of organizing for high reliability in order to improve preventable errors in healthcare in a significant way. This is primarily because the principles are theoretical and often hard to operationalize and implement in practice. To date there is little research on this subject.

This study will have a significant impact on the way the Army Medical Department and the Military Health System organizes for high reliability. It is currently unknown how the Army has implemented these strategies and if there are any barriers/facilitators to implementation. If this can be codified, the organization could develop strategies to improve the implementation efforts. This would likely reduce patient safety errors to zero, which is the goal of the high reliability strategies. This would also contribute to the literature on high reliability in healthcare, where many organizations are struggling to implement these strategies.