HROs have been defined in terms of their results—namely, highly predictable and effective operations in the face of hazards that can harm hundreds or thousands of people at a time. In many organizations, reliability is achieved by simplifying and standardizing operational tasks and by anticipating and defending against organizational disruptions. Industries with more complex, interdependent, unpredictable, and unforgiving technologies, whose frontline experts know more about their work than do their supervisors, cannot rely solely on a factory model of “divide and monitor”. This is the situation in much of health care which is challenged by variability of individual patients, incomplete evidence bases, rapidly evolving technologies, and shifting financial and regulatory climates.