What is Press Ganey’s High Reliability Platform (HRP)?
In a complex and high-stakes environment like healthcare’s, safety can’t be left to chance. Press Ganey’s High Reliability Platform (HRP) and Patient Safety Organization (PSO) support healthcare systems in safety event reporting. By applying the five proven principles of high reliability organizations (HROs), they also help organizations move closer to the ultimate goal: zero harm.
High reliability is more than a goal. It’s a mindset and operational model. It’s what allows leading healthcare systems to maintain safety, quality, and consistency—even amid constant change and challenges.
So, what makes a high reliability organization, and how can your team put high reliability principles into practice to improve patient and workforce safety?
What is a high reliability organization?
A high reliability organization (HRO) operates in high-risk settings with consistently low rates of harm or error. In healthcare, this means delivering safe, effective care, every time, regardless of external pressures or internal disruptions.
At its core, an HRO is defined by its commitment to safety, ability to anticipate failure, and relentless drive to improve. They don’t wait for problems to arise. They actively look for them. And they don’t assume success is repeatable; they build systems that make it so.
What is an essential component of a high reliability organization?
One of the most essential components of an HRO is a commitment to safety as a core value, not just a compliance goal. In high reliability healthcare systems, safety isn’t siloed—it’s embedded across the entire culture, from front-line staff to the boardroom.
The 5 HRO principles that help keep patients and healthcare workers safe
The five characteristics of high reliability organizations—first identified in high-risk industries like aviation and nuclear energy—are now widely adopted in healthcare as key safety drivers. These HRO principles help organizations recognize risk, respond to failure, and continuously improve patient safety and improve workforce safety.
- Preoccupation with failure: HROs are constantly alert to the potential for failure—even in seemingly routine operations. They treat near misses as opportunities to learn and improve.
- Reluctance to simplify: Instead of jumping to conclusions or relying on easy explanations, HROs dig deeper to understand the full context behind a safety event.
- Sensitivity to operations: HROs remain closely connected to what’s happening on the front lines. Leaders understand the day-to-day realities of care delivery and stay attuned to early signs of breakdowns.
- Commitment to resilience: Instead of avoiding risk entirely, HROs build capacity to respond, adapt, and recover when things go wrong—minimizing harm and learning in real time.
- Deference to expertise: In high reliability organizations, decisions are made by the people closest to the issue, regardless of hierarchy. Front-line expertise is valued and empowered.
These principles of high reliability organizations form the foundation for safer, more consistent care.
How to implement the principles of high reliability organizations: Leadership sets the tone
Becoming an HRO starts at the top. All leaders—not just safety leaders—must model a deep commitment to safety, actively encourage reporting, and align strategic priorities around reliability and trust.
What is the focus on safety and high reliability?
The focus of safety and high reliability is proactive risk management—spotting weaknesses before they cause harm, and building systems that support accountability, workforce resilience, and learning. But it's not just about reducing harm: It's about building a culture where harm has no place to hide.
Strategies that work
Implementing HRO principles requires deliberate strategy and sustained effort. Some proven tactics include:
- Safety rounding with real-time feedback
- Structured debriefs after clinical events
- Optimizing learning from your safety event reporting platform to enhance safety
- Embedding health equity into root cause analysis
- Using artificial intelligence to detect hidden safety trends
- Creating psychologically safe environments for speaking up
How Press Ganey supports high reliability
Through our High Reliability Platform and PSO, Press Ganey helps organizations adopt these strategies at scale. This lets teams move from reactive to proactive—from preventing harm, to designing it out of the system. Our safety event reporting platform, PSO, and unrivaled expert support all work in sync to help you achieve your safety goals.
Achieving zero harm starts with high reliability
There’s no shortcut to achieving a culture of safety. But the HRO model gives healthcare organizations the blueprint. The organizations that succeed are the ones that embed reliability into every process, prioritize front-line insights, and commit to continuous learning.
Ready to strengthen safety and build a culture of high reliability at your organization? Explore Press Ganey’s safety and reliability solutions, or connect with our team, to take the first step.