“Be alert. Keep Calm. Think Clearly. Act Decisively”   – Rule #6 (of the 10 Standard Fire Orders)                       In the last two posts I have focused on preoccupation with failure and reluctance to simplify, two of the five central principles of high reliability organizing. In this installment we will be turning our attention to Sensitivity to Operations and continue to draw parallels between the emergency department and other HROs. Where the first two are more cerebral this principle strikes at the heart of action-oriented enterprises. Like those who fight wildfires* we emergency providers are action-oriented. We have the individual and organizational dispoition  well suited to initiate and carry out immediate and aggressive care. Our actions are often tightly coupled (See Introduction) and frequently made without fully developed knowledge of the conditions we face. As such there…