VHA sought to reduce preventable harm in its vast network of hospitals and clinics, which served nearly nine million Veterans. Due to the size and complexity of the system, hospitals had developed inconsistent processes, increasing the risk of patient harm. VHA aimed to create a unified culture of safety using five HRO principles: deference to expertise, reluctance to simplify, sensitivity to operations, commitment to resilience and preoccupation with failure.
VHA partnered with Aptive to deliver mission-critical operational support that advanced the Journey to High Reliability. Aptive led multiple work streams, supported interagency coordination and provided evidence-based tools to guide implementation. The team helped design and execute strategies to shift organizational culture and improve safety outcomes.
Aptive collaborated with VA Employee Education Services to design eLearning modules and instructor-led training sessions. More than 300,000 VHA staff completed HRO 101 and HRO 201 courses. Executives, supervisors and front-line staff also participated in tailored HRO baseline training. Aptive supported additional learning through Lean Management and Clinical Team Training sessions.
From FY20 to FY22, Aptive conducted 134 hospital assessments to evaluate the maturity of HRO practices. The team delivered diagnostic reports outlining strengths, risks and tailored strategies to reduce medical errors. Each report included implementation plans with advisory support and maturity guidance. Aptive also enhanced the VHA HRO Maturity Matrix to broaden its application across organizational levels.
Continuous Learning Infrastructure
Aptive launched multiple learning initiatives to sustain HRO practices, including the HRO in Practice (HIP) pilot, a Community of Practice and a High Reliability Academy. These offerings created peer-to-peer learning environments and curated resources to help staff apply HRO principles to daily work. Aptive also delivered foundational training for HRO leads and champions, equipping them to influence and coach teams through operational performance improvements.
To support adoption of HRO principles, Aptive developed an internal messaging strategy aligned with mission-critical service delivery. The team built and maintained a SharePoint portal and launched internal campaigns such as the Safety Story Video Challenge, which collected over 80 examples of near-miss reporting. Aptive created fact sheets, blogs, newsletters and videos to reinforce key messages and celebrate success. A semi-annual award ceremony recognized HRO champions across the system.
VHA achieved widespread adoption of the HRO model, with over 300,000 employees completing training and 90% of executives meeting program milestones. Tailored implementation plans were adopted nationwide.
Based on hospital-level success, VHA expanded the initiative to include Central Office program offices. Aptive led this expansion, coordinating the launch with nine offices and nearly 1,900 participants. The team conducted interviews, delivered kickoff sessions, hosted over 250 leader training sessions and supported eight action plans to integrate HRO principles into office operations.
Through these efforts, Aptive helped VHA build a stronger safety culture, improve service delivery and reduce variability in care.
Over 300,000 employees completed foundational training
90% of executives completed targeted learning
134 hospitals implemented customized improvement plans
