Safety first! How leadership drives high reliability

Becoming a high-reliability organization, or HRO, is a major goal for complex health systems. Achieving this goal means focusing on safety and minimizing errors across all Defense Health Agency military hospitals and clinics. It also requires strong, active leadership. 

“Our strong focus on high reliability is more than just a clinical aim; it’s a critical mission,” said Deputy Assistant Director for Medical Affairs and Chief Medical Officer of DHA Dr. Paul Cordts. “It starts and ends with our leaders. We must show our commitment to zero preventable harm and build a culture where safety is everyone’s personal duty.” 

How leaders build a culture of high reliability 

In HROs, leaders make safety a top priority. They support continuous learning and push for innovation and growth. They create a shared vision for safer care, and they take personal responsibility for shaping the work culture. So, what does this look like in practice?  

“As nurses, high reliability is at the core of everything we do to bring care to military families. Strong, caring leadership builds trust and contributes to a culture of safety. It gives our front-line staff the confidence to speak up and make changes that can save lives,” DHA Chief Nursing Officer Dr. Kristen Atterbury explained. 

Leaders foster this kind of culture through clear and consistent actions. They follow key habits and values, including: 

• Modeling principles: Demonstrate ready, reliable care principles in how you approach your daily work. 
• Integrating safety and quality: Make safety and quality part of every task and goal. 
• Fostering trust: Build trust by being open, listening closely, and giving honest feedback. 
• Championing a just culture: Support a fair system where people are held accountable in a balanced way. 
• Leveraging expertise: Use everyone’s skills and knowledge, no matter their role or rank. 
• Ensuring psychological safety: Make sure staff know they can speak up about risks without fear of punishment. 
• Empowering through resources: Give people the tools and training they need to improve how they work. 
• Celebrating progress: Set up ways to thank staff and celebrate their success. 
• Fostering a supportive environment: Create a workplace where people grow, and teams do their best work. 

These habits help turn big ideas into daily actions. That’s essential for any organization working to become a true HRO. “The way we reach high reliability may look different across teams or specialties. That’s OK,” said DHA Chief Dental Officer Air Force Col. (Dr.) Donald Sheets. “What matters is that we share one vision — from our top leaders to our newest staff. That shared focus helps us deliver the safest, highest-quality care for every patient.” 

DHA’s journey toward high reliability is deeply connected to its leadership. By following the ready, reliable care principles, building trust, empowering teams, and keeping safety at the center, leaders help turn goals into real, lasting change. And that work leads us closer to one clear, critical goal: zero preventable harm across all care settings.