Context: Health care organizations are integrating employee training and educational programs to designate themselves as high-reliability organizations (HROs). HROs continually strive to evaluate and create an environment in which potential problems are anticipated, detected early, and virtually always responded to early enough to prevent catastrophic consequences. Objective: This primer document introduces the concept of high reliability in health care (from a historical and foundational perspective) and establishes a framework for athletic training educators to introduce the concepts at the professional, post-professional, or residency educational program level. Background: While the theory of high reliability is new to athletic training, its quality and origins in health care are established. HROs use systems thinking to evaluate and design for safety and continuous improvement to create an environment where potential problems are anticipated, detected early, and responded to early enough to prevent tragic consequences. Synthesis: The HRO focuses attention on emergent problems and deploys strategies to address those problems. HROs behave in ways that seem counterintuitive--they do not hide failures; instead, HROs celebrate them. HROs seek out problems and avoid focusing on just 1 aspect of work to see how all the parts fit together. They expect unexpected events and develop capabilities to manage them, deferring decisions to empowered experts. However, high reliability is only achieved through robust process improvement, which is only achieved with a complementary approach to Lean Six Sigma and change management. Recommendation(s): Given the complexity of patient care in athletic training, the potential for medical error(s), and the need for quality improvement, HROs hold promise for athletic training. Conclusion(s): As future health care leaders, athletic trainers should be educated to foster innovation and improve health care delivery to diverse patient populations. Athletic trainers should want to embrace the principles of HROs. Achieving high reliability can be accomplished with adequate exposure to and training within the classroom and during clinical education opportunities.