I grew up in Buffalo, NY, where I saw some of the first Bills’ games at my father’s side.  I sincerely hope that my writing about the Patriots in an admiring way does not cause him to turn over in his grave.

I cannot help wondering whether having an 18-0 record has as much to do with high-reliability systems as it does with outstanding coaching and players.  High-reliability organizations (HROs), such as the nuclear power industry and large-jet commercial aviation, display the following characteristics (Amalberti et al. Five System Barriers to Achieving Ultrasafe Healthcare. Annals Int. Med 2005; 142(9):756-764):

• Clear policies and procedures to mitigate risk and promote high-quality performance
• A performance measurement and tracking system
• Positive and negative incentives to reinforce and correct behavior

HROs display a culture of trust, shared values, and communication in excess of norms to mitigate risk and achieve outstanding outcomes.  According to Amalberti et al., only blood-banking and low-risk (ASA I) anesthesiology have outcomes comparable to the nuclear power industry and large-jet commercial aviation.

What do you think?

• Are there policies and procedures where increased clarity could promote better clinical outcomes
• Have we invested in and perfected cutting-edge performance measurement and tracking systems that give feedback in real time rather than months afterward
• Can we learn valuable lessons from other industries, or should sports analogies be banned from healthcare

I welcome your input.