Every day, laboratory professionals work in environments where the smallest error can have outsized consequences. Whether handling infectious agents, hazardous chemicals, or complex instrumentation, the stakes are high, and the margin for error is slim. That means that the laboratory workplace should be considered a high-reliability organization (HRO). To ensure the laboratory embraces the spirit of a HRO, safety must become not just a goal but a way of life.
What is high reliability? Why does it matter?
High reliability organizations are those that “operate under very trying conditions all the time and yet manage to have fewer than their fair share of accidents.” The concept was born out of research in fields like aviation, nuclear power, and the military — industries where failure is not an option. These organizations face complex, hazardous systems daily, but through rigorous processes and a relentless focus on safety, they achieve remarkable safety records.
In the laboratory, the parallels are clear. The technologies and products handled are risky, the consequences of error can be severe, and the environment is often unforgiving. Laboratorians cannot afford to learn from catastrophe. Instead, they must proactively manage risk, anticipate failure, and create systems that are resilient to human error.
The five principles of high-reliability organizations
To view the lab as a high-reliability organization, five core principles must be observed, grouped into the categories of anticipation and containment. The first principle of anticipation is Preoccupation with Failure. Every small error should be treated as a symptom of a larger issue. Near misses should never be ignored. Instead, report, investigate, and learn from them. Sensitivity to Operations is the second principle of anticipation. Labs need to stay attuned to what is happening on the front lines. Leaders should spend less time in the office. They need to listen to staff, observe workflows, and be present in the lab. The last anticipation principle of a high-reliability organization is the Reluctance to Simplify Interpretations. The culture of the laboratory should encourage diversity of thought and experience. Avoid oversimplifying problems when they arise, dig deeper to understand the true causes of laboratory incidents.
The first principle of containment is a Commitment to Resilience. It is vital for the laboratory to develop the ability to detect, contain, and recover from errors. When something goes wrong, bounce back quickly and learn from the event. This can be particularly helpful when implementing new technologies or processes and when working in collaboration with other departments. The second containment principle is known as a Deference to Expertise. Labs should push decision-making to those with the most relevant knowledge, regardless of their position in the hierarchy. For example, if a department build or remodel is underway, be sure to use an architect with lab-specific experience and include those who work on the front lines when designing the workspace.
Human behavior: The heart of safety
Risk in any environment is a function of both probability and consequence. While it may not be possible to reduce the consequences of a potential incident (for example, the outcome of a hepatitis exposure), the safety program can work tirelessly to reduce the probability of that incident occurring. By doing so, the lab can be recast as a low-risk department. A place where, despite the dangers, accidents are exceedingly rare.
Unfortunately, even in low-risk environments, human beings are fallible. Even the best-trained, most conscientious lab professionals make mistakes. However, high reliability is not about eliminating human error. It is about designing systems that anticipate, catch, and mitigate those errors before they lead to harm.
Dr. James Reason developed a Generic Error Modeling System (GEMS) that describes three performance modes in which errors occur. While working in the Skill-Based mode, routine tasks are performed on “auto-pilot.” Unfortunately, the more familiar one becomes with a task, the less attention is paid to it. Errors here are slips or lapses, often due to distraction or complacency.
In the Rule-Based performance mode, tasks are guided by established rules or procedures. The worker has adequate experience to make decisions about the work performed. Errors here arise from misinterpretation or applying the wrong decision.
The Knowledge-Based mode is in use when new or unfamiliar situations arise and where problem-solving is required. The worker does not have any past experience to go by when making decisions. Typically, errors will stem from making incorrect assumptions or from missing vital information. The arrival of the Covid pandemic, for example, brought labs several situations in which decisions had to be made with no prior experience.
While a high-reliability organization might have systems in place to reduce risks, humans are still able to make mistakes. In the lab, this means that even experienced staff are vulnerable to error, especially during routine activities.
From blame to systems thinking
When an incident occurs, the natural reaction is to blame the individual. But in high reliability labs, it is always important to look at the system first. What in the lab’s processes, procedures, or environment allowed the error to happen? Could it have been prevented by better design, clearer communication, or more robust checks?
If someone in the department trips over a loose cord, leadership should not simply ask why they were not paying attention. A system focus would drive questions about why the cord was there in the first place. Is there an existing system for identifying and fixing trip hazards? Are regular safety rounds conducted? This focus can better lead to systemic fixes, which prevent future incidents and create a stronger culture of safety.
Tools for high reliability: Making safety visible and actionable
Safety in the laboratory must be visible and ever present. This means regular education and training, establishing safety champions in every department, and making safety a standing agenda item in every meeting. When staff see that safety is a priority for leadership, it becomes a priority for them.
Recognize staff who ask questions, suggest fixes, or take initiative to address safety issues. Celebrate stand-out safety performance. This not only reinforces positive behaviors but also encourages a culture where everyone feels responsible for safety.
Leaders must be present in the lab — not just seen but seen doing and asking about safety. Rounding to influence bridges the gap between administrative discussions and front-line realities. It shows staff that leadership cares and is actively looking for ways to improve safety.
Conduct regular safety audits and encourage everyone to use their “safety eyes” as they move through the laboratory. Notice issues, follow up quickly, and close the loop on corrective actions. The faster hazards are addressed, the more trust will be built within the lab team.
Communication is the lifeblood of high reliability. Daily huddles—whether in person or virtual—keep safety top-of-mind and provide a forum for discussing ongoing issues, new hazards, and progress on corrective actions. High-reliability boards (see Figure 1), posted in the lab, make safety visible and invite staff to contribute concerns and solutions. When staff see that their input leads to action, engagement soars.
Safety checklists are also a hallmark of high reliability. Sadly, not all checklists are created equal. Effective safety checklists are concise, focus on critical steps, and use language familiar to staff. They should be tested and refined to ensure they actually improve safety, not just add paperwork. The true value of checklists is cultural—they enhance teamwork, improve communication, and shift responsibility for safety from individuals to the entire department.
Building a safer culture: The high-reliability laboratory
When books are written about high-reliability organizations, laboratories are often not mentioned. Given these organizations’ characteristics, however, it is clear that labs belong in that arena. A true high-reliability laboratory is a place where safety awareness is high and ever present. Incidents are rare, and when they occur, they are thoroughly investigated for systemic causes. Staff feel empowered to speak up about safety concerns. Leaders are visible, engaged, and committed to continuous improvement. Communication is open, frequent, and focused on learning, not blame. If these things exist in your laboratory, the results will be a safer culture, fewer incidents with injuries or exposures, and a laboratory that truly lives up to its mission of protecting patients and staff alike.
As Mark V. Rosenker, former Chairman of the National Transportation Safety Board, once said, “Safety is not a lucky system. It is a system of science, analysis, and facts.” High-reliability safety in the laboratory does not happen by accident. It requires commitment, vigilance, and a willingness to learn and adapt. By embracing the principles and tools of high reliability, we can create laboratories where safety never sleeps—and where every team member goes home safe, every day.
