Sharp HealthCare San Diego, with a Malcolm Baldrige National Quality Award, Magnet recognition, and Planetree designation, is bringing the High Reliability Organization (HRO) concept to its operations as part of the ongoing journey of performance improvements. HRO organizations portray specific characteristics designed to minimize risk. This case study webinar will illustrate how the Sharp team created the new Ocean View Tower, a 170,000-square-foot, 138-bed hospital addition, to go beyond just good practice to a “hardwire the environment” scenario for zero harm to patients, visitors, and staff. The presenters will describe the planning, design, and construction from each of their perspectives and share outcomes and critical lessons learned.