Published on: April 23, 2026 at 12:15 pm
By Nick Keppler
What can doctors and hospital administrators learn from the crews of aircraft carriers and nuclear power plants? How to make fewer mistakes.
The latter two are what management researchers call high-reliability organizations, ones that, considering the complexity of their operations, make relatively few significant errors. Understanding why could unlock potential for improvement for a variety of industries, including healthcare, said Academy of Management Scholar Christoper Myers of Johns Hopkins University.
“The idea is, essentially, trying to look at practices of organizations that have managed to stay error free, or nearly error free, for very long periods of time, even though the odds are stacked against them,” Myers said.
“Aircraft carriers are a risky proposition when you really sit down and think about it, the idea of launching and landing multi-million-dollar jets on something basically the size of a football field, rolling in the ocean, full of fuel and bombs, and that has a nuclear reactor at the bottom of it and is staffed by 18-year-olds who might have never been to sea before,” he said.
“We should be losing aircraft carriers left and right, and yet we don’t.”
Much has been written about how high-reliability organizations get their results. Experts in this field have identified five key pillars of HROs’ performance as sensitivity to operations, preoccupation with failure, reluctance to simplify, resilience, and deference to expertise.
One might hope for this kind of methodical thought and sterling results in a hospital setting. Yet hospitals often have a long journey to get to high reliability, as Myers and Academy of Management scholar Kathleen Sutcliffe recently described. Though estimates vary, experts agree that preventable medical errors harm thousands of patients every year in hospitals. These harms have immense human costs, as well as financial impacts in the billions of dollars annually.
Why do some of the most extensively trained professionals in the workforce make so many grievous mistakes, especially when high-reliability organizations have shown that errors can be minimized?
Myers has written extensively about organizational practices in hospitals and medical clinics. Their problems do not stem from “anything about any one particular individual and how smart they are or how accomplished they are,” he said. “It’s about the systems that are put in place.”
The shortcomings of the performance of healthcare personnel stem from many complex reasons, he said, but one underlining issue is that the culture of medicine often puts more responsibility on individuals than teams.
“Healthcare has been seen as an individual sport for a long time,” all the way back to the traveling doctor making house calls,” Myers said.
Often medical errors stem from miscommunications or a lack of communication among the many people working together to deliver care.
“When we look at root-cause analyses of errors in hospitals, it very often boils down to some sort of interpersonal thing,” Myers said.
Maybe one doctor did not provide enough information to the physician starting the next shift or a nurse who saw a patient’s health worsen at night but was hesitant to wake an on-call surgeon.
This contrasts with the characteristics of high-reliability organizations, which emphasize coordination and attention to overall processes, Myers said.
“They’re thinking about—at a very fine, granular level—how everything is getting done, how it all adds up,” he said.
