Response to: Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Editor—The work by Greig and colleagues¹ brings to light conflicting organizational and management practices for the operating theatre. A majority of the confusion and tension in this high-pressure environment can be traced back to the fundamental misunderstanding of high-reliability organizations (HRO) and ultra-safe systems (USS). In fact, the authors state that "health care providers aspire to become high-reliability organizations, but this practice contrasts with existing high-reliability organizations, such as aviation, where decision-making aids and standardized operating procedures are widely used."¹ However, the aviation industry is predominantly an ultra-safe system, not a high-reliability organization.

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