Want to Be a High-Reliability Hospital? Rethink How You Communicate

TABLE OF CONTENTS

To deliver the best care for patients, clinicians have to process a lot of critical information. That information needs to be both timely and accurate.

So what happens when the workflows that facilitate the movement of patient data aren’t reliable? Risk becomes a much bigger part of the picture.

To prevent undue risk, hospitals commit to becoming high-reliability organizations (HROs) built on a foundation that delivers consistent care, eliminates variation, and improves patient outcomes.

At the center of it all, both in workflows and in the way institutional knowledge is shared, is care team communication and the systems in place to support it.

Communication touches almost every aspect of patient care, so when challenges like dated technology or lack of shared understanding about protocols cause communication to break down, a hospital’s reliability might just break, too.

“When hospitals communicate in multiple modalities, they form gaps in knowledge and shared understanding,” shares Kelly Conklin, a former nurse and CNO who now serves as Chief Customer and Clinical Officer at PerfectServe. “Where those gaps exist, harm happens.”

To avoid those gaps, hospitals must embrace the principles of high-reliability organizations and design systems, processes, and culture—including care team communication workflows—that promote shared understanding, encourage vigilance, and keep patients safe.

What’s a high-reliability organization, and why does it matter for hospitals?

HROs share one reality: they have no choice but to operate reliably.

As Drs. Karl E. Weick and Kathleen M. Sutcliffe explain in Managing the Unexpected: Resilient Performance in an Age of Uncertainty, people who work in high-stakes settings—nuclear aircraft carriers, air traffic control and operations systems, hostage negotiation teams, and emergency medical treatment centers—make determined efforts to act mindfully and design processes that allow them to spot the unexpected before anything escalates out of control.

For hospitals and other healthcare organizations, that means delivering repeatable positive outcomes for teams and patients. “HRO hospitals focus on safety and quality outcomes,” shares Miriam Halimi, SVP of Client Services at PerfectServe. “They’re obsessed with improving workflows that make care safer and more predictable.”

But unlike formal hospital accreditations or designations, HRO status isn’t something hospitals earn, says Annie McCoy, who started her career as a nurse and now supports several hospital Patient and Family Experience advisory councils in addition to working as an advisor for AdvisorRN. Instead, she says that becoming an HRO is “cultural and it comes from a commitment to safety that hospitals establish as a core value.”

Why hospitals must operate like HROs

Hospitals’ reputation and dependability hold significant weight: they drive patient safety, reduce variation in care, prevent harm, build patient trust, and most importantly, support regulatory performance. In short, it shows they take patient care very seriously.

High-quality standards drive patient safety

Patient safety is the defining characteristic of any reliable hospital, and it stems from high-quality standards around processes, accountability, and a culture where everyone feels empowered to speak up when something doesn’t look or feel right.

“It’s operational rigor that makes processes successful,” explains Kelly. “In an operating room, for example, everyone should feel comfortable saying, ‘Wait a minute, that’s not right,’ in the interest of safety.”

That same rigor also shows up across workflows, including structured communication frameworks like SBAR (Situation, Background, Assessment, Recommendation) and read-back protocols that reinforce clear and shared understanding among teams.

Repeatability reduces care variation

“Repetition builds expertise, and in hospitals, that reduces risk. Reducing variability increases predictability,” explains Annie. “The more hospitals rely on predictable, repetitive processes, the less likely they are to experience adverse outcomes.”

Consistency, however, requires more than good intentions. “Resist shortcuts that seem like they save time,” adds Kelly. Instead, she recommends following processes, trusting data, and letting outcomes drive adjustments.

Reliable communication prevents harm

Unfortunately, communication breakdowns aren’t uncommon in hospitals. In fact, according to our report,Why Clinician Wellness Starts with Operational Wellness, 87% of clinicians reported experiencing communication-related friction like delayed responses, misrouted messages, and breakdowns with third-party providers.

When teams can’t rely on consistent communication, the likelihood of risk and harm goes up. Decisions lag, clinicians lack key details, and patient safety is compromised. Reliable communication changes that by unifying care teams, eliminating fragmented workflows, and supporting continuity across the entire care journey. Clinicians need to have the best, most current information available at all time to make the right decisions for their patients.

Market differentiation and patient trust

People instinctively recognize reliability. They also notice when it breaks, especially inside hospitals.

Patients expect care to be effective and consistent. When it’s not, trust erodes, and with it, a ripple effect that impacts reputation, word-of-mouth recommendations, and patient satisfaction scores.

Reliability helps regulatory performance

While HRO status isn’t a formal hospital accreditation, the systems and culture it promotes do support official regulatory and compliance processes.

Regulatory bodies look at measurable data, like low rates of adverse outcomes. But as Annie says, hospitals can only achieve these metrics by “building reliable, predictable systems in their organizations.”

The 5 principles of HROs

Reliability in a healthcare setting doesn’t happen by chance. Instead, it’s guided by 5 well-established principles defined by Drs. Karl E Weick and Kathleen M. Sutcliffe in their book Managing the Unexpected: Resilient Performance in an Age of Uncertainty.

You can also read more about HROs in healthcare here: Joint Commission’s High-Reliability Healthcare and IHI’s Framework for Safe, Reliable, and Effective Care

In our conversations with Annie, Miriam, and Kelly, we asked them to reflect on each principle and how they show up in the real world.

1. Preoccupation with failure

Success matters, but HROs focus on failure, too.

“They anticipate failure because they know humans are involved,” explains Annie. “They’re committed to identifying root causes and reducing risk through data-driven analysis.”

2. Reluctance to simplify interpretations

When something goes wrong, it’s easy to default to a quick explanation or simple “fix.” HROs resist that instinct and instead use root cause analysis to determine what really happened and why.

“It’s about taking a step back from the individual and looking at the process,” shares Annie. “You have to understand the system and what happened if you want to improve it.” By digging deeper now, you’re more likely to avoid similar failure in the future.

3. Sensitivity to operations

In hospitals, care happens on the floor, not in the boardroom. That’s why HROs make every effort to stay connected to daily operations and the realities of daily care.

“There’s a lot that goes into operations,” says Miriam. “Every step is complex, so HROs work to understand that complexity because they know breakdowns increase risk.”

4. Commitment to resilience

The most reliable hospitals know it’s a matter of when, not if, something goes wrong. That’s why HROs build resilience into their culture and develop processes that protect teams, systems, and patients from the unexpected. “It’s the ability to move forward after hard events,” says Miriam. “To reflect and learn instead of getting stuck in the moment.”

That resilience is often cultural, too. As Kelly explains, hospitals that do this well empower staff to speak up without fear of retribution by implementing systems that make it easy to do so. “Some hospitals,” she notes, “use electronic communication boards where they can flag concerns, near misses, or opportunities to improve.”

5. Deference to expertise

“Work my job for one shift and then tell me how to do my job better.” That quote from a nurse practitioner in our survey captures a broader sentiment: frontline teams want (and, quite frankly, deserve) a voice.

PerfectServe leaders agree. Miriam, who has over 20 years of experience as a registered nurse and 15 years as an informaticist, explains: “In Magnet-certified organizations, there’s shared governance that allows everyone involved in patient care to have a say. HROs appreciate and understand the importance of hearing those voices.”

Annie builds on that idea by emphasizing that expertise isn’t always tied to someone’s title. “The VP of Operations isn’t always the most knowledgeable person about a specific topic. What matters is finding the person with the most direct understanding of that process.”

Why communication is central to high-reliability organizations

When we think about hospital reliability, it’s easy to focus on clinical protocols, wait times, or surgical outcomes. But none of that works without reliable hospital communication systems.

Disconnected channels create knowledge gaps

Clarity and timing often determine whether care is effective. But when teams lean on fragmented tools, or too many messages slip through the cracks—maybe because 70% of clinicians use at least three communication tools—information is delayed, lost, and becomes much harder to act on. It’s no surprise, then, that over half of our survey respondents said they sometimes, often, or daily receive messages too late to make a difference.

“There are medications we can only deliver within certain time windows,” shares Annie. “If there’s a delay, that patient’s condition can deteriorate.”

Kelly adds that when clinicians feel rushed, they sometimes default to assumptions. “They’re busy, so they think they understand someone,” she explains. “But without a complete and shared understanding, they might give the wrong answer.”

Communication failures lead to sentinel events

According to the Joint Commission, 70% of sentinel events stem from communication breakdowns caused by the limitations of systems that weren’t built for hospitals.

Systems that:

Operate in siloes across teams and patients
Lack the context or data needed to inform decisions
Sit isolated from core systems and tools
Are unreliable, unsecured, or inaccessible when needed most

“The systems have to be reliable,” says Annie. “Whether I’m the one reaching out or the hospital is contacting me, I need to trust the system will lead to the right outcome.”

Communication failure extends across the system

Communication failures are rarely isolated, and even a small gap can trigger a chain reaction that extends across the hospital and compromises patient outcomes.

But when communication is clear, coordinated, and timely, teams can act quickly and confidently. Annie recalls one hospital that reimagined its stroke response around a single team alert in PerfectServe.

Once the ED team initiates contact, the platform automatically analyzes on-call schedules and notifies the right team members. If needed, repeat callbacks and escalation protocols occur automatically, which helped reduce on-call neurologist response time by 90%.

Now, the hospital can track and analyze call times and patient data to address areas of concern and continuously improve the process. That kind of visibility is only possible with integrated communication platforms.

How integrated communication platforms help hospitals become HROs

That’s just one example of what’s possible. Across hospital systems, integrated communication platforms help teams operate with more consistency by reducing variability, closing information gaps, ensuring shared understanding among teams, and preserving critical data that supports patient safety, compliance, and ongoing improvement.

Reduces variability

Fragmented or unclear communication pulls staff away from their core responsibilities, and that’s often when variability creeps in.

“We want to make it simple for one team member to reach the right person without delays,” says Annie. “Technology should act as the connective tissue that supports communication and enables everyone to work at the top of their license.”

Closes information gaps

Hospitals run on experience and knowledge, but when that lives in siloes—often with senior staff—it creates inconsistency and risk.

In contrast, documented and consistent communication essentially codifies tribal knowledge into institutional knowledge. “Some clinicians have decades of experience, and some have 6 months,” explains Miriam. “You can’t rely on tribal knowledge, which is why communication platforms that institutionalize workflows, documentation, and alerts are so important to keep everyone aligned, regardless of tenure.”

Ensures shared understanding

Consistent care depends on standardization and shared context. “Standardization protects the clinical process,” explains Miriam, “but it also reduces costs and inefficiencies.”

Kelly notes that this shared understanding becomes especially important during handoffs when communication is most vulnerable. In fact, 87% of clinicians in our survey reported confusion or friction during handoffs.

“I might need to communicate with 5 people in a patient-centered way,” she says. “I need 1 channel, so I’m not playing a game of telephone, and everyone stays aligned.”

Preserve access to historical data

“You can’t underestimate the importance of the historical data,” says Annie. “Legal, quality, and risk teams all rely on that communication trail to see who sent what and the corresponding decisions that were made.”

That visibility is also critical when investigating adverse outcomes, but it depends on using a communication platform that securely retains data longer than the limited retention windows typically associated with tools (including the electronic medical record) not purpose-built for healthcare communication and collaboration.

The cornerstone of high-reliability healthcare organizations

Hospitals depend on teams that act consistently, decisively, and with shared context. None of that is possible without timely, accurate, and reliable communication. To use Annie’s words, that’s because communication is the connective tissue between so many different processes that propel patient care forward.

Despite that, many hospitals still count on inefficient and unreliable systems, which is why less than half of clinicians said they feel very confident they can reach the right person in critical moments, and just 38% said their current communication system consistently helps them to prioritize messages.

A unified clinical communication platform changes that by streamlining information flow, closing knowledge gaps, reducing the reliance on tribal knowledge, and ensuring a shared understanding so that every member of the care team can deliver the best possible patient care.

Learn more about the benefits and features of unified healthcare communication—and how to pick the best solution for your hospital.

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