Hotel Romeo Oscar (HRO): High reliability in practice

February 27, 2020  //  FOUND IN: Strategy & Leadership,
The U-M Advanced Genomics Core

At a recent team meeting, Joe Gregoria overheard a few colleagues discussing high reliability training. As they talked, several of them agreed that they did not understand why they had to attend the training because high reliability did not seem to apply to their scope of work in research.  

As an IT manager and software developer for the U-M Advanced Genomics Core, Biomedical Research Core Facilities, Gregoria understood his team’s initial reaction.

“To me, it was a very valid concern,” Gregoria said. “Even as I went through the training I knew it was going to be difficult for people in my area to understand how the material applies to us because it is easy to dismiss as only pertaining to patient care.”

After discussing the training as a team, however, the group determined that there were, in fact, several ways the training could help improve their work. 

“When the team talked about what the ultimate goal of our work is, we all decided that one of the most important things we do is ensuring the data we provide to our research faculty is accurate,” said Gregoria. “Once we made that decision, we worked together as a team to develop a checklist that will be shared by everyone on the team. With everyone utilizing the same checklist, we will reduce the chance for error and improve the reliability of our data and our work.” 

Universal skills and shared language

In much the same way as Gregoria’s team utilizing a single checklist, one of the main goals of high reliability training is to introduce all Michigan Medicine faculty and staff to a uniform set of universal skills and tools that everyone can use in their daily work.

For example, employees are being introduced to a set of Michigan Medicine “safety phrases” that were developed to encourage faculty and staff to use a shared language that will improve communication. 

“In just the last week alone, I have heard two different people say ‘I have a clarifying question’ before asking a colleague for additional information about a task,” said Gregoria. “Having these catchphrases is a very useful tool, especially when English may not be everyone’s first language. It helps to create a common language and establish that this is the way we do things at Michigan Medicine.” 

High reliability organizations also encourage use of the phonetic alphabet when spelling words or phrases, particularly over the phone, to ensure greater accuracy when transferring information.

According to Lori Lathers, senior training specialist for Nursing Clerical Services, this will help the organization get the right team members in place as quickly as possible.

“For example, when a clerk is requested to call for the Rapid Response Team, there may be confusion if they simply read off ‘RRT,’ as that can be misinterpreted over the phone as ‘RT,’ or respiratory therapy,” Lathers said. “By using the phonetic alphabet, the right teams will be called to the right unit, room and bed each time, reducing miscommunication and, in the end, reducing risk for patient harm.”

Culture of safety

Another goal of high reliability is creating an environment in which all faculty and staff feel empowered and encouraged to speak up for safety.

“Speaking up in the middle of a surgery can be intimidating for providers and learners,” said George Mashour, M.D., Ph.D., chair of the Department of Anesthesiology. “The high reliability training helped reinforce my sense of responsibility — both as a clinician and as a department chair — to foster a culture of openness in which the expression of safety concerns can be rewarded.”

Participating in the training is just the first step — truly incorporating high reliability skills and tools into the culture of Michigan Medicine will take the dedication of all faculty and staff, with the support of leadership at all levels of the organization.

“This training is merely the beginning of a cultural conversation regarding how we can be the safest institution in the world,” said Mashour. “We have an ethical and moral obligation to protect our patients and colleagues each and every day.”

To register for high reliability training, log into MLearning and register for SAFE-90239. The course should appear in your “My Learning” plan but if not, you can search for it using the search bar.

If you have any questions or problems with registration, please email