title: Current medical staff governance and physician sensemaking: a formula for resistance to high reliability.
abstract: OBJECTIVE
  To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.
  
  
  METHODS
  A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.
  
  
  RESULTS
  Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.
  
  
  CONCLUSIONS
  Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.
  
  
  CONCLUSIONS
  If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.
  
  
  CONCLUSIONS
  Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.
  
  
  CONCLUSIONS
  The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.
authors.affiliation: San Juan Regional Medical Center, University of New Mexico, Health Sciences Center, Farmington, NM, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Flitter
authors.forename: Kelly Rouse
authors.initials: KR
authors.lastname: Riesenmy
authors.forename: Daved
authors.initials: D
authors.lastname: van Stralen
mesh_terms: D018166:Health Care Reform / Q000458:organization & administration*; D006739:Hospital Administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results