Leading High-Reliability Organizations in Healthcare: 1st Edition (Hardback) book cover

Leading High-Reliability Organizations in Healthcare

1st Edition

By Richard Morrow

Productivity Press

235 pages | 55 B/W Illus.

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Hardback: 9781466594883
pub: 2016-03-15
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The Institute of Medicine, Centers for Medicare and Medicaid, The Joint Commission, and other regulatory and accrediting bodies all agree that hospitals must be transformed into places where each patient receives quality care, every single time. In other words, zero defects. Helping to ensure quality at every level, high-reliability methods offer healthcare leaders the tools they need to achieve this noble goal.

Leading High-Reliability Organizations in Healthcare details the attributes and practices that help high-reliability organizations (HROs) excel in the service they provide to their customers. Explaining what it takes to achieve high reliability in healthcare settings, it defines reliability as much more than just being safe, it describes how to measure reliability and paves the way to higher reliability.

The book presents proven tools, concepts, and skills that leading healthcare organizations are using to improve safety and quality, including mistake proofing, Lean Six Sigma, and reliability engineering.

It details the roles and responsibilities of the two key organizational components involved in achieving high reliability: leadership and the reliability "engineers" who apply reliability methods both technically and socially throughout the healthcare value stream.

Rick Morrow, executive in HROs and now System Director of Quality, Safety, and Process Improvement at CHRISTUS Health, one of the largest non-profit healthcare systems, identifies the necessary infrastructure, methods, and analytics required to achieve and sustain higher reliability. He also suggests applications of high reliability concepts that have proven to work well in healthcare settings.

The book includes numerous case studies that illustrate success stories of healthcare organizations achieving higher reliability, some achieving zero defects for years. It also contains case studies that examine examples of failures, so you can avoid making the same mistakes.


"Working with Rick Morrow for two years, I know that he puts into practice what he writes in this book. The evidence from successful hospital departments in reliability shows what his teachings will do to move your hospital continually in the positive direction."

-Elizabeth Gentry, Ph.D., Assistant Professor, Director, Online Masters in Eng. Mgmt., Department of Industrial Engineering, University of Louisville

Table of Contents

Reliability – Able to Rely

Leadership and Engineering Reliability

Reliability Is about Clinical Outcomes

Reliability Defined

Measures of Reliability

Common Measures of Reliability

Mean Time to Failure and Mean Time between Failures

Reliability Enhanced without Compromise

Probability Measures of Reliability

Data Characteristics in Reliability Analysis

Censored Data

Failure Modes

Leadership Principles in High Reliability Organizations (HROs)

Reliability Begins with Design

Malcolm Baldrige National Quality Award and Reliability

Culture of High Reliability Organizations

Safety Cultures

Principles Common among HROs

Elements of an HRO

Management Principles in HROs

Practice Makes More Reliable

Standardized Work History

Healthcare Leaders in Practice

Visual Management of and for Reliability

Leading Change with Training Within Industry (TWI)

Achieving High Reliability in Functional Outcomes

Reliability Begins with Truth in Measurement

Patient Experience Improved Reliability

Pay-for-Quality vs. Fee-for-Service Drives Reliability

Achieving Higher Reliability in Safety Outcomes

Safety Engineering


A Texas-Based Healthcare System on the HRO Journey

Achieving 100% Reliability Case Study

The Roadmap to High Reliability

Methodologies Overview

Robust Process Improvement at The Joint Commission and Center for Transforming Healthcare

High Reliability Roadmap that Works

History of Healthcare Reliability

W. Edwards Deming

Reliability and Six Sigma – An Interview with Mikel Harry – Co-Founder of Six Sigma

Healthcare Reliability Promoted


Capability: The Precursor to Reliability

Process Control and Capability

Capability Case Study

Performing Capability Analyses

Three Capability Measures

Bilateral and Unilateral Tolerances

Capability Indices

Six Steps to Calculate and Analyze Capability

Kicking a Goal and Capability the Concept

Minitab’s Assistant Feature in Capability Analysis

Design for Reliability

Unifying Instructive Force

Pre-Production Part Approval

Advanced Product/Service Quality Planning

Failure Mode and Effects Analysis (FMEA) Case Studies

System FMEA

Healthcare Clinical Standards and Conditions of Participation in Reliability Design

Rolled Throughput Yield (RTY)

RTY Defined

Inspection Is Not Reliable

Total Knee and Hip Replacement and Reliability

Defects and Abnormalities

Theory of Escaping Defects

Checklists in Healthcare

Graphical and Statistical Methods for Reliability


Statistical Process Control (SPC)


Infrequent Event SPC Charting

Financial Impact

Cost of Poor Quality

Activity-Based Costing


Population Health

Value Streams in Accountable Care Organizations

About the Author

Rick Morrow is a consultant with more than 25 years of senior leadership experience in the healthcare, aviation, construction, automotive, and high tech industries. Morrow leads the quality, safety, and high reliability unit of Healthcare Performance Partners, a MedAssets company. He has authored Lean Six Sigma performance excellence courses and taught and deployed programs internationally for Eaton Corporation, SKF, Motorola, United Airlines, The Joint Commission, and Healthcare Performance Partners.

Morrow is the author and leader of HPP’s Six Sigma consulting. He wrote and leads the Belmont University Lean Healthcare Certification Program for Supply Chain Professionals, which is a blend of The Toyota Production System, Six Sigma, and Change Leadership. Morrow also wrote and taught The University of Pennsylvania’s Penn Medicine Leadership and Performance Improvement courses. He authored the Lean Six Sigma Program at The Joint Commission and steered its Center for Transforming Healthcare, where he and his team led collaborations improving patient care and safety with major academic medical centers including Cedars-Sinai, Johns Hopkins, Mayo Clinic, Intermountain Healthcare, North Shore Long Island Jewish, and Stanford University.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration