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Description The integration of High Reliability organizing and a Just Culture framework is essential to achieve and sustain optimal patient outcomes. Safety culture is ineffective without a ‘Just’ culture to support it. Trinity Health Grand Rapids (THGR) deliberately aligned high reliability with a system of workplace justice to achieve a sustainable culture of safety and care excellence ( figures 1 and 2). Safety culture survey data highlighted the need to build trust, psychological safety, and a healthy reporting culture to reduce harm (figures 3 and 4). Utilizing a strategic high reliability roadmap aligned with Just Culture principles and methods, THGR realized improved staff perceptions of safety and consistent safety behavior practices, leading to noteworthy harm and claims reductions (figures 2 and 5). Rethinking our approach to safety was critical following a period of backsliding. Senior leaders reflected on the importance of a Just Culture leading to increased ownership, investment and a renewed partnership between clinical and HR leadership. With justice as a core tenet, we have a stronger and more sustainable reliability roadmap aligned with our core values. Bottom line: Without a culture committed to workplace justice, safety science remains theoretical. We are now a system that not only thinks reliably but acts justly.Abstract 29 Figure 1THGR safety question pulse survey trends October 2022–February 2025Abstract 29 Figure 2THGR serious safety event rate January 2021–March 2025Abstract 29 Figure 3THGR rate of events reported per 1,000 adjusted patient daysAbstract 29 Figure 4THGR average rolling and monthly events reportedAbstract 29 Figure 5THGR claims reduction trend 2017–2024