The keynote address, "High Reliability Healthcare: Lessons from Naval Aviation," was presented by Steve Kreiser, a senior consultant with Healthcare Performance Improvement (HPI), a firm that works to improve human performance using methods from high-risk industries. HPI has been working with YNHH on HRO for the past two years.

"In a high-risk environment like aviation or health care, you have to be right every time," said Kreiser, a former FA-18 pilot with more than 20 years of leadership and management experience in the U.S. Navy. "The key to high reliability is teamwork and leadership."

According to Kreiser, there are five principles of HROs:

1. Preoccupation with Failure: Operating with a chronic wariness of the possibility of unexpected events that may jeopardize safety by engaging in proactive and preemptive analysis and discussion
2. Sensitivity to Operations: Paying attention to what's happening on the front-line — ongoing interaction and information-sharing about the human and organizational factors that determine the safety of a system as a whole
3. Reluctance to Simplify Interpretations: Taking deliberate steps to question assumptions and received wisdom to create a more complete and nuanced picture of ongoing operations
4. Commitment to Resilience: Developing capabilities to detect, contain and bounce back from errors that have already occurred, before they worsen and cause more serious harm
5. Deference to Expertise: During a high-tempo operation, decision-making authority migrates to the person or people with the most expertise with the problem at hand, regardless of rank "HROs are not perfect," said Kreiser.

"We have events from time to time. But we have to make sure steps are put in place so a serious safety event never happens again."

"The reality is that harm can happen on our watch and in our hospital," added YNHH Chief Medical Officer Tom Balcezak, MD. "But serious safety events are preventable and a continuous journey towards ZERO is the only acceptable goal. We can improve reliability and safety by the right mix of process, people and system design."