Rooted in human factor science, psychology, and sociology, the concept of high reliability first appeared during World War II with a focus on improving equipment design and human effectiveness. In his 1978 book Man-Made Disasters, Barry Turner indicated that up to that time the focus had been on disaster response (rather than disaster prevention).1  He suggested that processes, as well as simple errors, contribute to disasters, setting the stage for the study of industries successful in preventing catastrophic errors, such as aviation and nuclear power.1  In health care, the high-reliability movement began to accelerate in 2000 after To Err Is Human2  revealed that medical errors and adverse events were the root cause of an estimated 99 000 deaths annually in the United States.3  Unfortunately, errors remain a major cause of death today.4 

Organizational culture is key to creating high reliability.5  Key tenets of...

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