Caveats for high reliability in healthcare.

Purpose Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice. Design/methodology/approach Classic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care.

The relationship between safety climate and recent accidents: behavioral learning and cognitive attributions.

Objective: The association between accidents and subsequent work unit safety perceptions was assessed to address cognitive and behavioral changes following accidents.

Background: Many studies attempt to predict accident rates using measures of work unit safety, but effects vary considerably. Conversely, this study examined whether recent accidents may be positively associated with work unit safety perceptions, as suggested by behavioral learning mechanisms (increases in safety investments following accidents) or cognitive mechanisms (defensive attributions regarding accident causality).