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Invited Commentary
October 2014

Bundling for High-Reliability Health Care

Author Affiliations
  • 1Department of Surgery, The Johns Hopkins University, Baltimore, Maryland
JAMA Surg. 2014;149(10):1053. doi:10.1001/jamasurg.2014.389

The aviation and other industries with low-frequency but catastrophic events have embraced the model of high-reliability organizations. First described by editor Todd LaPorte1 and later popularized by Weick and Sutcliffe,2 high-reliability organizations are characterized by operational sensitivity, resilience mechanisms, experience with deference, recognition of complexity, and a preoccupation with failure. Health care has risks similar to those of these industries but creates other obstacles not necessarily well suited to high-reliability organizations. Specifically, the tribelike culture of medicine means that many of the fixes to the health care system will need to come at the unit level rather than institutional, systemic solutions. For example, efforts in intensive care units have established that central line–associated bloodstream infections and ventilator-associated pneumonia can be eliminated with a culture of safety and fidelity to evidence-based checklists.3,4

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