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The journey toward high reliability is complex and involves every aspect of an organization. The role of the governance or the board of directors is essential. Table 4.8 identifies questions board members should ask to ensure that the health care organization is focused on safety (American College of Healthcare Executive, 2017). Nurse leaders must put resources in place and create a culture so that these questions can be answered affirmatively.

Table 4.8 Questions to Confirm a Healthcare Organization's Focus on Safety

Is safety positioned as an uncompromising core value?Is there a comprehensive plan for improving patient and workplace safety and for monitoring progress?Is transparency embraced for sharing adverse patient safety events and lessons learned across the system?Is there a healthy reporting environment and a fair and just culture?Is respect expected for patients, co‐workers, and physicians within the organization?Are patient stories heard regularly?Are quality and safety implications considered for every major organizational decision?Does the board of directors or governance structure devote sufficient time to safety, quality, and the patient experience of care?

Source: Patti Ludwig‐Beymer.

Becoming an HRO involves creating a culture of safety and reliability. This type of culture improves safety, an important element for an effective, efficient health care system. Similarly, a culture of high reliability enhances quality. In addition, a culture of reliability enhances the patient experience. Afterall, what patients or family member is pleased if their care is unsafe or of poor quality? Last, a culture of safety and reliability improves the financial performance of a health care organization.

Much of the early work on safety and high reliability was done in other industries, like commercial aviation and nuclear power. These industries experienced major safety improvements because of their focus on high reliability principles. Health care organizations can apply what has been learned in other safety‐focused industries to improve patient safety.

Regardless of role and setting, nurses must apply the six QSEN competencies to enhance safety. Nursing organizations, interprofessional organizations, government agencies, and accreditation agencies serve as valuable resources when building a culture of safety and high reliability. Nurses are in a strong position to advocate for patient safety and lead interprofessional efforts to achieve high reliability.