Preventable medical error is a leading cause of death in the United States. While high-reliability organization (HRO) implementation efforts have become widespread, they often lack integration across culture, learning systems, and ambulatory care. A large health system launched a systemwide HRO improvement effort to drive reductions in serious safety events (SSEs), improve safety reporting culture, and align executive leadership with frontline safety practice. This is a retrospective observational study conducted between January 2019 and June 2025 across 12 hospitals and over 90 ambulatory clinics. The systemwide HRO intervention included leadership development, a unified safety reporting system, tiered safety huddles, and structured root cause analysis feedback. Safety culture scores were measured using Agency for Healthcare Research and Quality surveys in 2021 and 2024. SSEs were standardized as serious safety event reports (SSERs) per 10,000 patient-days. Hospital SSERs decreased significantly by 71% ( P < 0.001 for trend). Ambulatory SSERs increased due to enhanced harm detection efforts, but not significantly ( P = 0.356 for trend). Safety culture composite scores improved in 11 of 13 individual domains, with the largest percentage improvements in scores for leadership support and communication. A systemwide, unified HRO approach that holistically incorporates HRO-aligned standard work, executive leadership alignment, and proactive systems design can result in lasting preventable harm reductions and cultural transformation.
Keywords: Healthcare; health systems; high-reliability organization; safety.
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