I think I’m a pessimist. I have come to believe that most things in this world are driven by the incentive to make money. I imagine that current HROs such as aviation are driven by the high cost associated with failure, but such analyses are not readily available in health care. The idea of creating a high reliability organization in health care appears to oppose the current constant push to increase productivity in hospitals. However, improving outcomes, decreasing litigation, increasing compliance, and decreasing complications should inevitably decrease costs to hospitals. By presenting these ideas from the cost decreasing aspect, I wonder if we could align our interests towards patient safety and quality improvement with the purely economic interests of policy makers and care organizations. We would be able to incentivize existing leadership in our organizations by speaking their language, rather than trying to change the game. Cost analysis of quality improvement projects is starting to be included in many analyses and published data, but often as an after thought. I would like to learn how we can make it more integral in our discussion of QIPS.