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Integrating traditional biomedical and high reliability organisation approaches: solving puzzles and problems
  1. Peter J Pronovost1,
  2. Simon C Mathews2,
  3. Jill A Marsteller3,
  4. Kathleen M Sutcliffe4
  1. 1 Departments of Anesthesiology and Critical Care Medicine, and Surgery, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Department of Medicine, School of Medicine, Johns Hopkins University, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  3. 3 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  4. 4 Carey Business School, Johns Hopkins University, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Peter J Pronovost, 600 N. Wolfe Street, CMSC 131, Baltimore, MD 21287, USA; ppronovo{at}jhmi.edu

Abstract

Objective To describe the important distinctions between traditional biomedical and high reliability organisation (HRO) approaches in advancing healthcare delivery. To further describe how these two concepts can be integrated in a learning health system to improve care for patients, providers’ experience and healthcare organisations’ effectiveness.

Methods and analysis A description of how HRO and traditional biomedical approaches address problems in healthcare is provided, along with a description of their key characteristics. This is followed by a discussion on how to combine these concepts synergistically to the benefit of all stakeholders in a learning health system.

Results Health systems are challenged to become learning health systems but the path toward this goal is not well described, particularly on how to integrate existing approaches.

Conclusion HRO and traditional biomedical approaches are important strategies to improving healthcare. However, they fundamentally address the challenges in healthcare differently. It is important to find ways to integrate these concepts to achieve maximum benefit in a learning health system.

  • total quality management
  • management system
  • patient safety
  • learning organisation

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Footnotes

  • Contributors JM and KS reviewed the manuscript and provided substantial edits and thematic changes.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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