John Kello began researching and consulting in occupational safety in the early 1980s. He helped his local public utility strengthen their approach to safe operations in their nuclear power plants. Working with nuclear control room teams in the simulator, John and his colleagues developed training in crew coordination for safe operations, focusing on clear communication, prompt and effective feedback, workload distribution, group problem-solving, and stress awareness and stress management. The work they did laid the foundation for standards of training for the entire nuclear industry, standards that are still in effect.

Based on his experience with the nuclear industry, John was invited to work with pioneering researchers and practitioners focused on safety in the airlines. He joined the team that established the first team-training programs for pilots, known as Crew Resource Management (CRM) programs. The challenges of working effectively and safely as a flight crew paralleled the challenges that he had been helping nuclear control room crews tackle. While their work with CRM was initially embraced by some (though not all) domestic airlines, it was encouraged and supported by the Federal Aviation Administration (FAA). Over time, the FAA decided to mandate such training for all pilots, in initial training as well as in regular recurrent training, and that mandate is still in effect.

Through his early research and consulting with the nuclear industry and the airlines, John and his colleagues began to focus their attention on error management, recognizing that the data showed clearly and consistently that the primary contributing cause of incidents in both industries was human error, often involving miscommunication (communication that was unclear, unverified, or absent). They began to see that nuclear operations and aviation were high reliability organizations (HROs), as that concept was beginning to emerge in the research literature. The common denominator for HROs is highly complex and hazardous work requiring extensive training and certification, and the consequences of an accident would be catastrophic, so that work had to be done right every time. Errors must be avoided, or at least isolated and corrected.

As researchers started to apply the HRO concept to healthcare, John began researching medical error (co-authoring The Burned Out Physician), focusing initially on doctors but quickly recognizing that everyone in the broader healthcare-delivery system has the same risk of error, potentially catastrophic error. With a focus on error reduction, he developed a streamlined, simplified, behavior-based approach to occupational safety that can be applied in any work setting. While work settings such as mining, construction, and manufacturing typically do not meet the strict HRO definition, accidents do happen, and people do suffer injuries in those workplaces, with human error as the main culprit. John and his team have brought evidence-based, best-practice safety principles derived from their extensive work with HROs into a wide range of industries. That sums up their approach to occupational safety.