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Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales / MANISHA KUMAR

Swansea University Author: MANISHA KUMAR

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DOI (Published version): 10.23889/SUthesis.57556

Abstract

Patient safety and providing a high quality of care are the prerequisite requirements for the effective and efficient operation of any healthcare organisation. However, alarming statistics of errors and adverse events continue to grow with effective organisational models to guide the reduction and c...

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Published: Swansea 2021
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Rich, Nicholas
URI: https://cronfa.swan.ac.uk/Record/cronfa57556
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The healthcare sector requires a major reform in current practices and the holistic approach known as High Reliability Organisation (HRO) offers potential utility when delivering error-free performance and reliable care and has evolved from studies of safety-critical environments, yet it has received little academic attention for the healthcare setting. Despite more than two decades of HRO research, there is still a research gap in understanding how healthcare organisations can embrace the principles of HRO and what these principles mean. This research explores the meaning of HRO for healthcare professionals. As such, this doctoral research aims to develop a HRO theoretical model to understand the concept of the HRO as it applied within the context of the Welsh NHS setting. Two research questions were crafted for this study: RQ1- What are the perceived organisational features that enable higher reliability in the healthcare context? RQ2 - How the perceived organisational features interact with each other to enable higher reliability in the healthcare context? The narrative literature review process allowed the synthesising of the HRO literature and identifying the key organisational features that can enable high reliability practices in the healthcare setting. The outcome of the literature review was a conceptual HRO model of six interrelated organisational features (forming eleven hypotheses). These concepts included the mindful leader, training, communication, trust, reporting, and safety culture. The study is framed using &#x2018;sensemaking&#x2019; and &#x2018;systems&#x2019; theories as explanators of the HRO healthcare model. An online survey instrument was designed to test the HRO theoretical model in the Welsh NHS setting. Clinical and managerial workers from four Health Boards/Trusts (259 usable responses) participated. Structured Equation Modelling (SEM) was used to test the HRO model. The findings show that staff define HRO as the technical and socio-aspects for achieving high reliability performance; the revised HRO model identified that mindful leaders have a direct and significant impact on communication, training, and feedback. The mindful leader indirectly impacts safety culture through the mediation effect of communication, reporting, and trust. The training was found to have a direct impact on building trust and establishing good communication and reporting across the organisation. The revised HRO model, as a result of this study, provides a contextually specific (healthcare) understanding of HRO that differs greatly from other safety-critical contexts. The findings of the study have significant managerial and policy implications for the promotion and increased awareness of HRO amongst healthcare professionals and how to engage professional clinicians and professional managers who see HRO in similar but distinct forms. 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spelling 2021-08-09T12:19:56.5039793 v2 57556 2021-08-09 Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales 8caf68c647129d114a46ca46ded8d94a MANISHA KUMAR MANISHA KUMAR true false 2021-08-09 Patient safety and providing a high quality of care are the prerequisite requirements for the effective and efficient operation of any healthcare organisation. However, alarming statistics of errors and adverse events continue to grow with effective organisational models to guide the reduction and control of error rates. The healthcare sector requires a major reform in current practices and the holistic approach known as High Reliability Organisation (HRO) offers potential utility when delivering error-free performance and reliable care and has evolved from studies of safety-critical environments, yet it has received little academic attention for the healthcare setting. Despite more than two decades of HRO research, there is still a research gap in understanding how healthcare organisations can embrace the principles of HRO and what these principles mean. This research explores the meaning of HRO for healthcare professionals. As such, this doctoral research aims to develop a HRO theoretical model to understand the concept of the HRO as it applied within the context of the Welsh NHS setting. Two research questions were crafted for this study: RQ1- What are the perceived organisational features that enable higher reliability in the healthcare context? RQ2 - How the perceived organisational features interact with each other to enable higher reliability in the healthcare context? The narrative literature review process allowed the synthesising of the HRO literature and identifying the key organisational features that can enable high reliability practices in the healthcare setting. The outcome of the literature review was a conceptual HRO model of six interrelated organisational features (forming eleven hypotheses). These concepts included the mindful leader, training, communication, trust, reporting, and safety culture. The study is framed using ‘sensemaking’ and ‘systems’ theories as explanators of the HRO healthcare model. An online survey instrument was designed to test the HRO theoretical model in the Welsh NHS setting. Clinical and managerial workers from four Health Boards/Trusts (259 usable responses) participated. Structured Equation Modelling (SEM) was used to test the HRO model. The findings show that staff define HRO as the technical and socio-aspects for achieving high reliability performance; the revised HRO model identified that mindful leaders have a direct and significant impact on communication, training, and feedback. The mindful leader indirectly impacts safety culture through the mediation effect of communication, reporting, and trust. The training was found to have a direct impact on building trust and establishing good communication and reporting across the organisation. The revised HRO model, as a result of this study, provides a contextually specific (healthcare) understanding of HRO that differs greatly from other safety-critical contexts. The findings of the study have significant managerial and policy implications for the promotion and increased awareness of HRO amongst healthcare professionals and how to engage professional clinicians and professional managers who see HRO in similar but distinct forms. The contribution of the study is a healthcare specific description of HRO as a means of achieving higher system reliability. E-Thesis Swansea High Reliability Organisations, Healthcare, NHS, Survey, Sensemaking, Patient Safety 22 3 2021 2021-03-22 10.23889/SUthesis.57556 ORCiD identifier https://orcid.org/0000-0002-3211-3697A selection of third party content is redacted or is partially redacted from this thesis due to copyright restrictions. COLLEGE NANME COLLEGE CODE Swansea University Rich, Nicholas Doctoral Ph.D School of Management, Swansea University 2021-08-09T12:19:56.5039793 2021-08-09T10:42:28.9120823 Faculty of Humanities and Social Sciences School of Management - Business Management MANISHA KUMAR 1 57556__20580__ead3768f104e46f8b41ddd7c85f1b2bc.pdf Kumar_Manisha_M_PhD_Thesis_Final_Redacted_Embargoed_31.12.2022.pdf 2021-08-09T11:26:49.6507156 Output 4196549 application/pdf Redacted version - open access true 2022-12-31T00:00:00.0000000 Copyright: The author, Manisha Maneesh Kumar, 2021. true eng
title Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
spellingShingle Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
MANISHA KUMAR
title_short Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
title_full Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
title_fullStr Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
title_full_unstemmed Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
title_sort Interpreting the meaning of High Reliability Organisations in a healthcare context: A study of NHS Wales
author_id_str_mv 8caf68c647129d114a46ca46ded8d94a
author_id_fullname_str_mv 8caf68c647129d114a46ca46ded8d94a_***_MANISHA KUMAR
author MANISHA KUMAR
author2 MANISHA KUMAR
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college_str Faculty of Humanities and Social Sciences
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hierarchy_top_title Faculty of Humanities and Social Sciences
hierarchy_parent_id facultyofhumanitiesandsocialsciences
hierarchy_parent_title Faculty of Humanities and Social Sciences
department_str School of Management - Business Management{{{_:::_}}}Faculty of Humanities and Social Sciences{{{_:::_}}}School of Management - Business Management
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description Patient safety and providing a high quality of care are the prerequisite requirements for the effective and efficient operation of any healthcare organisation. However, alarming statistics of errors and adverse events continue to grow with effective organisational models to guide the reduction and control of error rates. The healthcare sector requires a major reform in current practices and the holistic approach known as High Reliability Organisation (HRO) offers potential utility when delivering error-free performance and reliable care and has evolved from studies of safety-critical environments, yet it has received little academic attention for the healthcare setting. Despite more than two decades of HRO research, there is still a research gap in understanding how healthcare organisations can embrace the principles of HRO and what these principles mean. This research explores the meaning of HRO for healthcare professionals. As such, this doctoral research aims to develop a HRO theoretical model to understand the concept of the HRO as it applied within the context of the Welsh NHS setting. Two research questions were crafted for this study: RQ1- What are the perceived organisational features that enable higher reliability in the healthcare context? RQ2 - How the perceived organisational features interact with each other to enable higher reliability in the healthcare context? The narrative literature review process allowed the synthesising of the HRO literature and identifying the key organisational features that can enable high reliability practices in the healthcare setting. The outcome of the literature review was a conceptual HRO model of six interrelated organisational features (forming eleven hypotheses). These concepts included the mindful leader, training, communication, trust, reporting, and safety culture. The study is framed using ‘sensemaking’ and ‘systems’ theories as explanators of the HRO healthcare model. An online survey instrument was designed to test the HRO theoretical model in the Welsh NHS setting. Clinical and managerial workers from four Health Boards/Trusts (259 usable responses) participated. Structured Equation Modelling (SEM) was used to test the HRO model. The findings show that staff define HRO as the technical and socio-aspects for achieving high reliability performance; the revised HRO model identified that mindful leaders have a direct and significant impact on communication, training, and feedback. The mindful leader indirectly impacts safety culture through the mediation effect of communication, reporting, and trust. The training was found to have a direct impact on building trust and establishing good communication and reporting across the organisation. The revised HRO model, as a result of this study, provides a contextually specific (healthcare) understanding of HRO that differs greatly from other safety-critical contexts. The findings of the study have significant managerial and policy implications for the promotion and increased awareness of HRO amongst healthcare professionals and how to engage professional clinicians and professional managers who see HRO in similar but distinct forms. The contribution of the study is a healthcare specific description of HRO as a means of achieving higher system reliability.
published_date 2021-03-22T04:13:23Z
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