Aviation is often cited as an example of an industry that has achieved high reliability—minimizing adverse events despite a complex and risky work environment. Hospitals may be very far from this ideal, but this article by the leadership of The Joint Commission presents a framework for hospitals to use in working toward high reliability. By synthesizing the literature on organizational safety and reliability from other industries, the authors identify three key domains critical to enhancing reliability: leadership engagement, development of a robust safety culture, and use of effective process improvement tools. Within these domains, developmental stages are presented (ranging from "beginning" to "approaching" high reliability) to help organizations evaluate their own progress toward high reliability. The article's lead author, Dr. Mark Chassin, was interviewed for AHRQ WebM&M in 2009.