How Does Employee Listening Work as a Sensor for Safety Risk?
The Healthcare Employee Experience Consortium, sponsored by Perceptyx for several years, has historically been limited to healthcare organizations. Manufacturing, construction, utilities, and transportation leaders joined the recent session on high reliability to share their experiences after Perceptyx shared insights from panel research we conducted specific to safety and high reliability in April.
When asked via a Zoom poll at the start of the session how familiar attendees were with High Reliability Organizational operating principles, nearly 20% shared they have heard the term, but weren't sure what it means or details of the principles, while over a third of attendees indicated a high level of expertise. We opened with a high-level overview of high reliability, including real-world illustrations, then shared research findings and facilitated a roundtable discussion across industries.
I have worked in employee experience for 15 years, with around 70% of my book of service being specific to the healthcare sector; other industries I support are manufacturing and aerospace engineering. My history in high reliability started early; my first job out of graduate school was at an aerospace manufacturer, and I earned my Six Sigma Green Belt to meet the high efficiency needs of my employers. To ensure adequate cross-industry expertise, I invited two Workforce Transformation Consulting colleagues to join me to offer broader perspectives. Sarah Jorgenson spent her whole career in manufacturing before Perceptyx and holds a Six Sigma black belt. Ame Creglow has considerable experience working with manufacturing and construction customers.
What Are High Reliability Organizations?
Safety culture refers to the shared values, attitudes, and behaviors that shape how an organization manages risk. While many organizations define safety culture broadly, the High Reliability Organizations ("HROs") framework, developed by Kathleen Sutcliffe and Karl Weick, offers five specific operating principles to put that culture into practice. Sutcliffe argued in 2019 that patient safety had barely moved in the 20 years since the Institute of Medicine reported on preventable hospital deaths; healthcare had not experienced the same reduction in harm that other industries have during the same timeframe. Sutcliffe observes that healthcare spent two decades studying what goes wrong, while not spending enough time studying what goes right, or learning from other industries. We structured this webinar to act on Sutcliffe's recommendations: share best practices and bring leaders from different industries into the same conversation.
What Do the Five High Reliability Principles Look Like in Practice?
Days prior to our webinar, two aircraft in Phoenix shared the same call sign, meaning they had the exact same flight number. Air traffic control typically uses call signs to differentiate between aircrafts and communicate with pilots. Headlines recapped the event, but listening to the exchange between the pilots and air traffic control revealed just how serious the situation was: "nearly disastrous," to paraphrase the controller.
Preoccupation with failure is the principle often misunderstood by those without HRO experience since the name may imply someone who is distracted by or anxious about what could go wrong. Instead, it relates to reading your surroundings, anticipating problems, and eliminating the possibility of failure before the opportunity occurs.
The controller illustrated this when he stayed in constant contact with the pilots of both aircraft, and added a designation to differentiate the planes: "the arrival" and "the departure." Even after confirming both pilots were aware of the situation and could see each other, and knew their flight paths to avoid collision, the controller continued to constantly confirm the flight path with both aircraft until their flight paths were no longer intersecting.
Immediately after the risk was over, the controller said, "I'm going to file an MOR" (Mandatory Occurrence Report): exemplifying reluctance to simplify, and identifying a root cause on why this very rare and potentially deadly event of two aircraft with the same call sign in the same airspace and using the same frequency occurred in the first place.
As the controller was providing instructions, and clearly was the expert best positioned to direct both aircraft safely through the overlapping flight paths, no one argued or debated the flight paths he laid out, nor the naming convention he derived to differentiate the aircraft. The pilots followed his exact instructions, and complimented him on his expertise given this unusual and dangerous situation. This illustrates the principle of deference to expertise, and in time-sensitive situations it is literally a life-saver.
Another principle, commitment to resilience, usually winds up misunderstood as simply recovery, since that's how we often use the term "resilience" in the employee experience space. However, under the HRO framework this also includes adaptability in the midst of a safety event. This controller later shared that he had never seen the problem in front of him in his 25 years of experience, and improvised how to differentiate the aircraft from one another in the moment.
The fifth and final HRO principle not illustrated in this event — but one that I hope occurs through the MOR investigation — is sensitivity to operations, which refers to leaders being aware of the challenges and events that occur among frontline staff. Leaders must solicit input directly from frontline staff to accurately identify root causes and prevent recurrence.
Does High-Hazard Work Lower Employee Engagement?
Perhaps surprisingly, no. Perceptyx ran a panel study in April 2026 of about 620 U.S. employees, across every leadership level and more than 20 industries, to validate a new high reliability assessment we've developed.
- Nearly half of the panel works for an organization that involves high-hazard work, which we defined as physical risk to yourself or others.
- 42% of respondents personally work in high-hazard roles.
- Three-quarters of panelists who work in high-hazard roles had been directly involved in a serious safety event during their career.
- Among these, 57% within the past year.
When I asked via Zoom poll whether webinar attendees thought high-hazard workers have lower engagement than their peers, two-thirds said no. They were right: engagement scored slightly higher among panelists who work in high-hazard roles, and the pattern held across most industries in the panel. This debunks a theory I've heard from many leaders across my career that "lower engagement is just part of the job: they have stressful, high-responsibility work." The important takeaway is that aspects of the workplace within our control impact engagement more than the inherent hazards of the role itself.
Perhaps even more surprisingly, involvement in a serious safety event barely impacted employee engagement scores, either. Engagement scores were around 85% (where the closer to 100% the better) among people who had never been personally involved in a serious safety event. Engagement was slightly over 82% among people who had personally been involved in a serious safety event in the past three months.
To summarize, our panel research offered two compelling findings:
- Simply working in high hazard roles does not lower employee engagement
- Direct involvement in a serious safety event does not lower engagement either
Instead, the panel revealed that the response to a serious safety event is what impacts engagement, and overall perception of one's organization being highly reliable and safe.
When Does Trust Dip After a Serious Safety Event?
Our research included asking participants how long it has been since they were directly involved in a serious safety event, with intervals as recent as 'less than three months ago', to 'over five years ago.' We found that six months after the event scores were the lowest on most metrics. In particular, favorability on "I trust this organization to address safety concerns appropriately" stayed high right after an event, but fell to its low point among people directly involved in a serious safety event six months after the event occurred. Another question on the panel followed the same trend, regarding whether the organization runs a complex, high-hazard environment safely and efficiently.
This implies that in the first weeks following an event, leaders communicate and investigations run, but by month six, the investigation has closed and the updates have stopped, perhaps sooner than the employee feels the investigation should have. Employees are left to wonder if any further improvement will occur, and sometimes may see behaviors revert back to unsafe standards that led to the event in the first place.
How Do You Tell Genuine Resilience From Workarounds for Broken Processes?
HR leaders in high-hazard environments face a version of this question constantly: how do you tell the difference between a team that's genuinely resilient and one that's simply compensating for a broken process? Sarah Jorgenson, who spent her career in manufacturing before joining Perceptyx, offered a clear test. Sarah shared an experience with a manufacturer she's supporting from earlier this year, and when she asked what they wanted to measure, the answer was, "We have a bunch of heroes around here, and that's what gets rewarded." This led to discussing the importance of objectively measuring high reliability principles. Real resilience reduces the need for heroes. One practical signal: near-miss reporting rates. A team that reports near misses frequently is demonstrating confidence that the organization wants to learn from close calls, while a team with zero reported near misses but frequent scrambling may be quietly absorbing risk. Deference to expertise means leaning on knowledge in the moment. Sarah shared an anecdote: "I see situations where we rely on Bob because Bob is the only one who can fix the machine. A team like that looks capable while it keeps delivering. [However] when that one person leaves, or staffing drops, or demand spikes, things fall apart."
In healthcare, the earlier warning signs may be subtler. I noted that items like "My opinions matter" and "Sufficient effort is made to get the opinions and thinking of people who work here" could be useful if they are asked as part of your listening strategy. Low scores among direct patient care staff tell me sensitivity to operations may be an opportunity, especially if trending down from prior surveys. A falling response rate can also be another early warning sign, as staff are no longer willing to share their feedback, usually due to waning confidence in their feedback resulting in improvements. Perceptyx AI Agents can surface early signals between formal survey cycles, giving leaders a real-time view of whether frontline staff feel safe to speak up — before a low response rate or a falling score becomes the first indicator of risk. As noted in the 2026 State of Healthcare Employee Experience, there was an 11.2-point drop in employees who agree that their manager values their ideas in the past year.
Ame calls her version the "sense of chaos." No incidents get reported, but staff feel workload or safety is in jeopardy. In this case, the organization should ask different questions than simply 'what is the incident rate?'. How often is the place scrambling, and how much energy goes into keeping a "mess" from becoming an incident? She notes that, in her experience, the answers usually come back to training. Her son is an emergency room physician at a children's hospital. After a high-profile case with a very sick child, she heard him say he was "lucky because everyone in that ER was trained well". This would, of course, look different in every organization. Leaders must identify the primary cause of unsafe or inefficient work before it becomes an incident.
What Does the Gap Between Procedure and Practice Look Like?
An HR leader at a transportation company told us about the near-miss of a potentially fatal accident. Her employees knew there had been an accident but they did not know the outcome yet, which gave her a short window where interest was high, and before the story hardened into an official version. She ran small focus groups where she showed a surveillance video of the incident, stopped it before the ending, and asked what happened next. Every one of them said they would have done what the employee in the video did, even though the company had taught them otherwise for years.
This HR leader promised nobody would be punished for answering, and then she asked staff why they would have responded in the same, unsafe manner as the employee in the video did. This revealed that the route the company taught employees to use could not actually be driven under real conditions (a lack of sensitivity to operations; not being aware of the standard experience of frontline staff). The HR leader shared that further discussion identified that shift leaders knew and had quietly accepted the workaround. "Go talk to the person doing the work before you assume your policy describes anything," she told us, adding "people will work around a broken process to get the job finished."
A Director for High Reliability and Safety at one of America's largest not-for-profit health systems sees a similar gap. Her organization utilizes Gemba walks, where a leader goes and watches the work happen (the meaning of "gemba" in Japanese is "the actual place" or "the real place"), from their operating rooms to their accounting departments. She was candid that leaders are busy and the walks cost real time, but they also show how the job gets done and are critical to safety and high reliability.
Her advice to anyone just starting this sort of work was to spend the effort on leadership first. A workforce, especially one that is very large, will not memorize a list of commitments. Her team built error prevention tools instead, which are small habits that travel anywhere in the system. For example: employees repeat back a medication dose or a project deadline to confirm they heard it right. To paraphrase her, 'in healthcare, the [university] degrees on the wall can silence the most junior person in the room.' Her organization has zero tolerance for retaliation for speaking up, so people can have more confidence about speaking their minds.
With that in mind, Perceptyx's own research has found that speaking up became harder overall this year. Scores on a question regarding comfort with asking questions when something seems wrong fell 15 points in our 2026 healthcare industry database. Agreement that 'it is safe to speak up' fell 4.6 points. Interestingly, both dropped in the same year employees reported more autonomy and clearer strategy. A non-punitive response to errors is widely recognized as a core attribute of safety culture, so these declines suggest that even organizations with clear policies may not yet have the psychological safety needed to close the gap between procedure and practice.
What Do High-Performing Organizations in High-Hazard Environments Do Differently?
Sarah's answer came out of Lean manufacturing, where the mantra was "chase waste". She interprets survey and employee listening data the same way. If we treat concerning feedback on surveys the same as a sensor indicating a problem with a machine, and treat it as part of the risk system to hunt for weak signals early, we can be more proactive. Beyond this, Sarah notes that what high performing HROs do well is to close the loop fast, because silence after a survey teaches employees not to bother reporting or speaking up next time. Engagement scores are also evaluated too; a score can remain stable while workload and questions regarding feeling safe to speak-up decline. That usually means committed people are shouldering a systemic burden.
Every organization wants safety, quality, speed, cost control, and innovation at once. In manufacturing the risk climbs whenever someone has to pick between doing the job safely and keeping it moving. HROs take that choice away. Raising a concern, stopping work, or asking for help counts as performance. This only works when leaders visibly commit to the same standard: participating in safety conversations, responding seriously to near misses, and allocating resources that match their stated priorities. Ame added that most surveys contain an item about safety being a priority. The real test is whether supervisors watch closely enough to know how people work on a "rainy day" when the job still has to get done. The person on the floor usually has the best idea for making a process safer, Ame pointed out, and has to feel safe enough to offer their input to leaders. She encourages organizations to reflect on what they do with the feedback they receive.
From my perspective, it's important to stress that closing the loop in healthcare takes longer than most leaders expect. Reluctance to simplify means the root cause analysis takes time, so keep telling people where the investigation stands. Too many organizations follow up once and move on. The six-month dip we found in our HRO research says the follow-up has to continue long after leaders feel their work is done. In our Perceptyx Benchmark Database, the question regarding 'Belief that the last survey resulted in improvements' fell 12.4 points over the last year.
What Comes Next at Perceptyx for Measuring High Reliability?
Perceptyx has a safety culture survey built for healthcare that was approved by Joint Commission and Leapfrog in 2023, with national benchmarks available today. We are currently validating this survey for other industries. The HRO panel research is being used to produce a high reliability survey of 15 items, three items per HRO principle, with a five-item pulse version. This survey will allow our customers to scale their HRO listening: they can assess perception of all five HRO principles, have a deep-dive on one or two of focus, or pulse on all five to best meet their needs.
The results of our panel study revealed commitment to resilience scored highest across industries, while reluctance to simplify scored lowest. This suggests that many organizations recover and train staff well, but investigate poorly. Healthcare, manufacturing, and construction had similar performance and relatively high scores compared to other industries such as agriculture which has the lowest ratings on high reliability constructs and safety.
Join the Healthcare EX Consortium for the next session. Read the 2026 State of Healthcare Employee Experience for a fuller picture on speak-up trends, or schedule a demo to see how Perceptyx measures safety culture and high reliability.