From HRO to HERO: Making Health Equity a Core System Capability

Area of Science:

• Healthcare Management
• Health Equity Studies
• Patient Safety

Background:

• Health systems increasingly adopt high-reliability organization (HRO) principles.
• Health equity is notably absent from current HRO discussions and applications.
• Health disparities reflect systemic failures in achieving reliable outcomes for specific populations.

Purpose of the Study:

• To propose the integration of health equity as a core component of HROs.
• To introduce the concept of High Equity Reliability Organizations (HEROs).
• To outline how equity aligns with the five core HRO concepts.

Main Methods:

• Conceptual analysis of HRO principles and health equity.
• Integration of equity into the five core HRO concepts: sensitivity to operations, preoccupation with failure, deference to expertise, resilience, and reluctance to simplify.

Main Results:

• Health equity is essential for achieving true high reliability.
• Systematic disparities are antithetical to the HRO goal of "zero harm."
• Equity can be integrated into all HRO core concepts.

Conclusions:

• High Equity Reliability Organizations represent a necessary evolution for healthcare.
• Integrating equity into HROs is critical for eliminating health disparities.
• Achieving high reliability necessitates a commitment to health equity for all patient groups.