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Should we expect high reliability organizations to have highly reliable compliance and ethics programs?

Margaret Hambleton ( is President of Hambleton Compliance in Valencia, California.

High reliability organizations (HROs) are those organizations that are able to sustain error-free performance even though they operate in highly complex environments where the consequences of errors could produce catastrophic results. Typical examples of HROs include organizations such as aircraft carriers, nuclear power plants, airlines, and air traffic control. More and more healthcare organizations are adopting the principles of HROs to promote quality and safety and prevent patient harm. The characteristics of HROs are surprisingly similar to highly effective compliance and ethics programs, so it would seem logical then that HROs should have similarly reliable compliance and ethics programs. In my review of the literature, however, I see little evidence that adopting HRO principles has much effect on an organization’s compliance and ethics program.

The objective of this article is to understand the characteristics of HROs, compare these with the characteristics of an effective compliance and ethics programs, and explore why HROs don’t necessarily leverage these characteristics to improve the effectiveness of their compliance and ethics programs, nor do effective compliance and ethics programs necessarily leverage these characteristics to ensure highly reliable safety systems.

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