The delivery of healthcare is complex. The intricacies of the healthcare system routinely place physicians and other healthcare providers in high-risk environments. High reliability organizations (HROs) offer insight into managing an environment with persistent risk. HROs develop a precise mindset and a corresponding set of operational patterns. A Daily Management System (DMS) is crucial for ensuring the operational capability needed to deliver safe and reliable care every day. The DMS has nine key components driven by organizational direction and values, and manifested through leaders’ standard routines. The intent of the system is to create a culture that is preoccupied with failure and has a tenacity for continuous improvement. The DMS allows all team members to participate actively in the journey toward highly reliable and safe patient care. This chapter will illustrate components of the system, explain their connectivity, and offer advice on implementation. The results of using a DMS in a department will be demonstrated, showing how a DMS contributes to the development of an HRO, with safety as a core value.