High reliability organisations refer to organisations or systems that operate in hazardous conditions but have fewer than their fair share of adverse events. (1,2) Commonly discussed examples include air traffic control systems, nuclear power plants, and naval aircraft carriers. (3,4) It is worth noting that, in the worker safety literature, HROs are considered to operate with nearly failure-free performance records, not simply better than average ones. This shift in meaning is somewhat understandable given that the "failure rates" in these other industries are lower than rates of errors and adverse events in process plants. This comparison glosses over the difference in significance of a "failure" in the nuclear power industry compared with one in the process industry. The point remains, however, that some organisations achieve consistently safe and effective performance records despite unpredictable operating environments or intrinsically hazardous endeavours. Detailed case studies of specific HROs have identified some common features, which have been offered as models for other organisations to achieve substantial improvements in their safety records. These features include: (1) Preoccupation with failure, the acknowledgment of the high-risk, error-prone nature of an organisation's activities and the determination to achieve consistently safe operations. (2) Commitment to resilience, the development of capacities to detect unexpected threats and contain them before they cause harm, or bounce back when they do. (3) Sensitivity to operations, an attentiveness to the issues facing workers at the frontline. This feature comes into play when conducting analyses of specific events (e.g., frontline workers play a crucial role in root cause analyses by bringing up unrecognized latent threats in current operating procedures), but also in connection with organisational decision making, which is somewhat decentralized. Management units at the frontline are given some autonomy in identifying and responding to threats, rather than adopting a rigid top-down approach. (4) A culture of safety, in which individuals feel comfortable drawing attention to potential hazards or actual failures without fear of censure from management