Demonstrating Deference to Expertise: Simple, Dynamic Tools to Ask, Listen, and Do What Care Teams Know Deliver Patient Safety and Optimize Workflow

Highly Reliable Organizations (HROs) are organizations that operationalize and achieve safety, quality, and efficiency goals by employing 5 key principles: 

“(1) sensitivity to operations (ie, heightened awareness of the state of relevant systems and processes)

(2) reluctance to simplify (ie, the acceptance that work is complex, with the potential to fail in new and unexpected ways)

(3) preoccupation with failure (ie, to view near misses as opportunities to improve, rather than proof of success)

(4) deference to expertise (ie, to value insights from staff with the most pertinent safety knowledge over those with greater seniority)

(5) and practicing resilience (ie, to prioritize emergency training for many unlikely, but possible, system failures)”

Leaders are challenged to adapt to new ways of working, new technology, and how to keep a burnout workforce connected and engaged. For years, quality and patient safety experts have focused on the 5 principles above to deliver safe and reliable care.  However, modeling these same principles in day-to-day behaviors, especially deference to experience, also empowers and engages care teams in person-centered improvements that create operational efficiencies and bring joy to the workplace. 

Already utilized leader and manager activities such as, leader rounding, walkabouts, shadowing, journey mapping, and tracing methods, provide opportunities to not only connect with frontline staff, but also to ask them qualitative questions to deep dive into operational workflows, ideas for improvement, and how to fix pebbles in their shoes.  Combining the what with the how enables leaders to value and act directly from staff insights who do the work. 

Shadowing and other low-cost, high-impact person-centered tools are ideal to capture and analyze feedback and valuable data from frontline staff so that their expertise can be spread and acted upon. In a Journal for Health Design article, goShadow’s method was used to increase operational workflow in an operating room setting by more than 21% by listening and acting from feedback from those that do the work. 

Ask, listen, and do what care teams know will co-produce efficiency, safety, and outcomes. Contact goShadow to learn best practices to integrate shadowing and other co-design tools into your already-existing leadership practices.


Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of High Reliability Organization Principles. Washington (DC): Department of Veterans Affairs (US); 2019 May. Available from:

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Posted on

June 24, 2022