Page 96 - JSOM Summer 2023

How the Five Principles of
High Reliability Organizations Align with the
Five Truths of Special Operations

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Adam Biggs, PhD *; Jenna Jewell, PhD ; Lanny Littlejohn, MD 3
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ABSTRACT
Special Operations medicine must provide highly reliable closer an organization can align with these principles—and the
healthcare under intense and sometimes dangerous circum- better their people understand them—the more likely the orga-
stances. In turn, it is important to understand the principles nization is to deliver high-quality healthcare.
inherent to building a High Reliability Organization (HRO).
These principles include (1) sensitivity to operations; (2) pre- Among the many examples used to teach HRO principles, mil-
occupation with failure; (3) reluctance to simplify; (4) resil- itary exemplars are especially common. Nuclear aircraft car-
ience; and (5) deference to expertise. Understanding them is riers might be the most frequent depiction of military HROs,
crucial to turning good ideas into sound practical benefit in and yet, an interesting coincidence has been largely ignored.
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operational medicine. A prime teaching opportunity involves In 1987, an evaluation of American and Soviet Special Opera-
an interesting coincidence that occurred during the emergence tions yielded five Truths in SOF, including (1) humans are more
of HROs. Specifically, United States Special Operations Com- important than hardware; (2) quality is better than quantity;
mand (USSOCOM) adopted five Special Operations Forces (3) SOF cannot be mass produced; (4) competent SOF cannot
(SOF) Truths that contribute to success in Special Operations, be created after emergencies occur; and (5) most Special Oper-
including (1) humans are more important than hardware; (2) ations require non-SOF support. These SOF Truths became so
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quality is better than quantity; (3) SOF cannot be mass pro- fundamental that the United States Special Operations Com-
duced; (4) competent SOF cannot be created after emergencies mand (USSOCOM) adopted them as crucial philosophical
occur; and (5) most Special Operations require non-SOF sup- guidance in supporting the most complicated and dangerous
port. These five Truths have more in common with the five American military missions. 8
HRO principles than merely quantity. They describe the same
underlying ideas with a key focus on human performance in When examining the five SOF Truths alongside the five HRO
high-risk activities. As such, when presented alongside the five principles, they have more in common than quantity. There is
HRO principles, there is an opportunity to improve the over- a remarkable amount of overlap in the underlying messages. In
all health and performance of SOF personnel by integrating turn, there is an opportunity to use both HRO principles and
these principles across the range of Special Operations medi- SOF Truths in conjunction when teaching these characteristics
cine from point of injury care to garrison human performance to new practitioners. Here, the intent is to illustrate how HRO
initiatives. The following discussion describes in greater detail principles and SOF Truths align as well as how their common
the five HRO principles, the five SOF Truths, and how these elements can enhance understanding of the combined ideas in
similar ideas emerged as more than just a useful coincidence supporting high performance. Thus, the goal is to provide ad-
in illustrating the key concepts to produce high performance. ditional training material to help new practitioners understand
the common characteristics of high-achieving organizations
Keywords: special operations; high reliability organization; capable of overcoming significant adversity.
HRO; resilience
HRO Principle #1 | Sensitivity to operations

SOF Truth #1 | Humans are more important than
Introduction
hardware
HROs are the gold standard for delivering quality health- The first HRO principle suggests that increased situational
care. In theory, the value involves selecting and training a awareness regarding relevant systems and processes helps
1,2
force capable of consistent high performance despite challeng- avoid errors. This principle requires knowing more than the
ing environments and complex systems. In practice, the key status quo. Effective personnel are aware of the big picture
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touchpoint involves teaching people how to implement HRO as well as how components fit together or how problems in
procedures. Teaching methods often involve describing the five one area may spill into other areas. In short, greater situa-
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core HRO principles, including (1) sensitivity to operations; tional awareness allows personnel to address potential failures
(2) preoccupation with failure; (3) reluctance to simplify; (4) in real-time before true damage is done. This idea aligns ex-
commitment to resilience; and (5) deference to expertise. The ceptionally well with the first SOF Truth—humans are more
4,5
*Correspondence to adam.t.biggs@gmail.com
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1 Dr Adam Biggs and Dr Lanny Littlejohn are affiliated with the Naval Special Warfare Command, San Diego, CA. Dr Jenna Jewell is affiliated
with the Naval Leadership and Ethics Center, Naval Newport Station, RI.
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