#117 – An Intro to Systems Thinking and High Reliability Organizations

Anesthesia Guidebook

Yo! This episode introduces the concepts of systems thinking and high reliability organizations. It’s the first part in a 3 part series. Part 2 is gonna dive into resilience engineering and safety differently. Part 3 is all about psychological safety and just culture.

These 3 shows unpack crucial intel for front-line providers, equipping them to understand their roles and how to develop their clinical impact. It’s also for organizational leaders and practice managers and will help you think about how to design better systems and support your team so they can thrive.

Systems thinking is the process of zooming out beyond simple cause-and-effect understanding (i.e. linear causality models) of how errors happen. It encourages people to consider the complexity of their environments and the power of leveraging changes in your processes and systems.

In this episode we cover:

• Learning organizations and their 5 characteristics:
  1. Personal mastery
  2. Mental models
  3. Shared vision
  4. Team learning
  5. Systems thinking
• High reliability organizations and their characteristics
  • Preoccupation with failure
  • Reluctance to simplify
  • Sensitivity to operations
  • Commitment to resilience
  • Deference to expertise
• How these ideas link to resilience engineering and safety differently

“Every organization is perfectly designed to get the results it gets” (Batalden, 2015).

If you don’t like the results you’re seeing, you need to change the system. Whether this is your anesthesia team, hospital/OR or your personal life. If the outcomes are not what you desire, you need to adopt a systems thinking approach to change. This episode will walk you through how to do that.

The values you embrace shape your culture. Your culture builds your systems. Your systems generate your results.

Quick reminder: I’m teaching at Encore Symposium’s Hilton Head conference May 19-22 and then again with their fall conference at the Cliff House here in Maine that runs October 20-23, 2025. I love seeing y’all in person at these conferences. If you come because you heard about it here on the show or are just there and have checked the show out before, come holler at me! I’d love to chat with you about what you’re up to and what your practice is like.

Be sure to check out Part 2 and 3 of this series and I’ll see you there!

References

Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com

Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202

Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303.

Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge.

Larouzee, J., & Le Coze, J.-C. (2020). Good and bad reasons: The Swiss cheese model and its critics. Safety science, 126, 104660.

Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. Broadway Business.

Sutcliffe, K. M. (2011). High reliability organizations (HROs). Best practice & Research clinical anaesthesiology, 25(2), 133-144.

Wears, R., & Sutcliffe, K. (2019). Still not safe: patient safety and the middle-managing of American medicine. Oxford University Press.

Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world. John Wiley & Sons.

World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care (9240032703).

If you don’t like the results you’re seeing, you gotta change the system! Every system is perfectly designed to get the results it gets!