High Reliability at a U.S. Air Force Outpatient Clinic: Have We Improved and Are We Ready for the Future

Date of Award

Summer 2021

Document Type


Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

George Velez

Committee Member

David Meckstroth

Committee Member

JoAnn Jordan


Preventable medical errors may now be the third leading cause of death in the United States, following only heart disease and cancer as the Nation’s biggest killers (Makary & Daniel, 2016). If that weren’t bad enough, it is estimated that the incidence of preventable medical errors that lead to serious patient harm may be 10 to 20 times higher than those that cause death (James, 2013). The vast majority of people across the globe will, at some point in their lives, require the services of a healthcare organization. During each of these encounters with an industry dedicated solely to improving health, they will be at significant risk for unintended harm and even death. In the United States, this healthcare issue was first presented to the public consciousness more than two decades ago when the Institute of Medicine published its report, To Err is Human Building a Safer Health System (Institute of Medicine [IOM], 2000). Today, after more than 20 years of industry focus, vast numbers of studies, and quality improvement recommendations, preventable medical errors still occur every day across the U.S. and around the world. Many healthcare organizations are trying to improve patient safety by adopting the principles of high reliability, including a preoccupation with failure, resiliency, and organizational mindfulness. The setting for this research is at a U.S. Air Force Tier-1 outpatient clinic. The high-reliability program that the Air Force Medical Service (AFMS) rolled out to all Medical Treatment Facilities (MTF) is called Trusted Care. This study sought to examine and reveal relational evidence between the principles of high reliability, preventable medical errors and perceived organizational patient safety culture through retrospective data analysis. Utilizing safety reporting data and the results of organizational culture surveys, the results of this study indicated that there is evidence linking the Trusted Care high reliability program to improvements in patient safety within the outpatient setting at the study organization.