Structural and Organizational Issues in Patient Safety: A Comparison of Health Care to other High-Hazard Industries

A recent report from the Institute of Medicine has focused attention anew on the incidence of medical errors in the health care industry. While there is a relatively large body of research on how organizations can operate in a highly reliable manner, and thus avoid such errors, little of that work has been done in the health care field. This article discusses the ways in which the health care industry has failed to meet systematically the standards for achieving high reliability, based in part on two existing theories about the management of high-hazard environments-High Reliability Organization Theory (HROT) and Normal Accidents Theory (NAT).