HJNO May/Jun 2021

46 MAY / JUN 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS COLUMN NURSING I HAVE COME to call these kinds of events ‘black swans,’a term I learned fromreading Nassim Nicholas Taleb’s New York Times bestseller, “The Black Swan.” 1 Prior to the discovery of Australia, people thought that all swans were white, their “reality” con- firmed by the sightings of millions of white swans throughout the world. The scientific description of black swans in 1790 2 gave the lie to our learning from observations or experiences. The term ‘black swan’ is now used to describe events with three characteristics: 1) the event is an outlier; 2) the event represents an extreme impact; and 3) although it is an outlier, humans are compelled to create explanations for its occurrence after the fact. In my lifetime, the most memorable black swans were the 911 terror attacks on Washington, DC and NewYork City. The COVID-19 pandemic of 2020/2021 can now be added to that list. Managing an unexpected event de- pends on institutions functioning as high- ly reliable organizations (HRO) that are adaptable and resilient in the face of ca- tastrophe. Good management means be- ing mindful of small, unexpected events as they are happening so that they can be managed, halted or contained before they become emergencies. What makes high reliance organizations effective is their reliance on mindfulness characterized by a vigorous response to minor disruptions that are often not recognized in many in- stitutional settings. Weick and Sutcliffe have developed a useful acronym for highly reliable organi- zations that engage in mindful organizing, designated as FSORE: Failure, Simplifica- tion, Operations, Resilience, Expertise. 3 I will use these five principles to summarize how LSBN functioned as an HRO during Bu i ld i ng High Reliance Organizations During Crisis If there is anything that the great pandemic of 2020/2021 has taught us, it is that 100-year events that impact the entire world and bring highly reliable governments, institutions and healthcare systems to their knees may not be able to be predicted, but they can certainly be anticipated given the world’s history.