Health systems are increasingly aiming to become high reliability organizations. This safety net hospital established systems for high reliability through leadership, safety culture, and robust process improvement with targeted areas for improvement in patient outcomes, public reputation, and lower cost of care. Patient outcomes (e.g., reduction in hospital-acquired infections) improved, which subsequently improved Hospital Compare star ratings. Efforts to achieve lower costs of care continue with improved efficiency of care and educating all clinicians on their contributions to hospital finances.