Fix These First: How the World's Leading Companies Point the Way Toward High Reliability in the Military Health System.

The 2014 Military Health System Review calls for healthcare system leaders to implement effective strategies used by other high-performing organizations. The authors state, " the [military health system] MHS can create an optimal healthcare environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times" (Military Health System, 2014, p. 1). Although aspirational, the document does not specify how a highly reliable health system is developed or what systemic factors are necessary to sustain highly reliable performance. Our work seeks to address this gap and provide guidance to MHS leaders regarding how high-performing organizations develop exceptional levels of performance.The authors' expectation is that military medicine will draw on these lessons to enhance leadership, develop exceptional organizational cultures, onboard and engage employees, build customer loyalty, and improve quality of care. Leaders from other segments of the healthcare field likely will find this study valuable given the size of the military healthcare system (9.6 million beneficiaries), the United States' steady progression toward population-based health, and the increasing need for highly reliable systems and performance.