Recent global health emergencies have exposed critical gaps in outbreak response capabilities:
Our research suggests that adopting proven high-reliability principles could address these challenges through systematic improvements to organizational structures, processes, and culture.
Through ongoing in-depth research with both industrial HROs and public health organizations, we're identifying:
What is a "High-Reliability Organization"?
High-Reliability Organizations (HROs) are organizations that operate in complex, high-risk environments yet maintain exceptionally low rates of catastrophic failures. Classic examples include air traffic control systems, nuclear power plants, aircraft carriers, and some healthcare organizations. These organizations have developed systematic approaches to managing risk, learning from experience, and maintaining performance under challenging conditions.
What are the five core principles of HROs?
To embed any or all of these principles, full leadership engagement is critical.
Why apply HRO principles to public health?
Public health, particularly outbreak response, shares many characteristics with traditional HROs: high stakes, complex systems, incomplete information, and severe consequences of failure. While public health has developed many effective practices, systematic application of HRO principles offers potential to further enhance reliability, particularly in coordinating complex multi-agency responses.
Is this approach proven to work in public health settings?
While HRO principles have been successfully applied in healthcare settings (particularly hospital safety), their systematic application to public health outbreak response represents new territory. Our research is designed to identify which principles transfer effectively and how they can be adapted to public health's unique context.
How can resource-constrained health departments implement these principles?
We recognize that public health often operates with limited resources. Part of our research focuses specifically on identifying high-impact, low-resource approaches and regional collaboration strategies that make HRO principles accessible to departments of all sizes.
In order to incorporate HRO principles into our health department, do STLTs need to implement all five principles at once?
No. Our preliminary findings suggest that implementing even one principle with fidelity can yield meaningful improvements. Many organizations begin with a single principle that addresses their most pressing challenges, then expand over time.
Won't standardized protocols based on HRO core principles reduce our ability to respond to outbreaks flexibly?
This is a common misconception. HRO principles actually enhance adaptability by distinguishing between processes that should be standardized (routine operations) and those that require flexibility (complex problem-solving). The goal is appropriate standardization that creates a reliable foundation for innovation when needed.
How do we measure success in becoming a high-reliability organization?
We're developing measurement frameworks tailored to public health applications. Initial metrics include:
The 7-1-7 model is an exciting framework to look at for considering metrics in Outbreak response.
Will this approach require significant organizational restructuring?
Not necessarily. Many HRO principles can be implemented through cultural and process changes rather than structural reorganization. The approach emphasizes working within existing systems to enhance reliability through targeted improvements. Active leadership engagement is critical for the success of this approach.
What research is being conducted by CORI on HRO principles and public health?
CORI is currently carrying out two complementary studies. This ongoing research examines how HRO principles can improve outbreak response capabilities on one hand, and examines best practices and lessons learned from foodborne and emerging disease outbreak management on the other.
What methods are you using in these studies?
Our mixed-methods approach includes:
How does the HRO project fit with CORI's broader mission of implementing modeling and analytics solutions?
The HRO project represents a foundational element of CORI's broader mission. While CORI helps STLTS to implement advanced analytics and modeling tools like RedCap for outbreak response, we recognize that these tools can only reach their full potential when implemented within systems designed for continuous learning and improvement.
High-reliability principles provide the organizational framework necessary for analytics tools to drive meaningful changes:
Throughout our research, we're documenting how these foundational capacities and reliability-focused infrastructure enable public health leaders to maximize the value of analytics innovations. The HRO project isn't separate from our analytics mission—it's what makes those analytics truly transformative.
How can my health department participate in this research?
We're actively seeking partner organizations interested in:
Ready to explore collaboration? Contact us at
CORI@jh.edu
Subscribe to CORI Digest for monthly research updates and new opportunities
Where can I learn more about HRO principles?
We are currently building a resource library of articles, case studies, and implementation guides tailored to public health applications introducing HRO concepts specifically for public health professionals. (coming soon)
A few helpful reads to learn more about HRO principles include:
Is funding available to support implementation projects?
CORI does not provide direct funding. If you are interested in carrying out implementation projects, we invite you to join our ORI-Net network
The Center for Outbreak Response Innovation is supported through Cooperative Agreement NU38FT000004 between CDC’s Center for Forecasting and Outbreak Analytics and Johns Hopkins University’s Bloomberg School of Public Health.
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