Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre–Post Quasi-Experimental Quality Improvement Project.

This article focuses on a quality improvement (QI) project evaluating the implementation of a high-reliability organization (HRO) framework across 139 Veterans Health Administration (VHA) hospital facilities from 2019 to 2023. Using a pre–post quasi-experimental design, the project compared outcomes in an initial cohort of 18 facilities (Cohort 1) with the remaining VHA sites, assessing changes in patient safety culture (PSC) and patient safety event reporting. Results showed broad improvements in PSC scores across all sites, with Cohort 1 demonstrating significantly greater gains in the dimensions of Risk Identification and Just Culture and Error Transparency and Risk Mitigation. Patient safety event reporting increased notably in Cohort 1, particularly for total events and close calls, suggesting enhanced organizational learning and psychological safety. The study acknowledges limitations due to nonrandomized site selection, adaptations during COVID-19, and inherent underreporting in safety event data, while highlighting the project's contribution to advancing large-scale HRO implementation in integrated health systems.