Patient-centered care is safe and eliminates preventable patient harm. Sports medicine teams that understand and apply the principles of high reliability, as demonstrated by high-performing communities in the US Navy, will provide safer, higher-quality care. Sustaining high-reliability performance is challenging. Leadership is essential to creating an accountable but psychologically safe environment fostering active engagement by all team members and resisting complacency. Leaders who invest the time and energy to create the appropriate culture and who model the required behaviors enjoy an exponential return on their investment in terms of professional satisfaction and the delivery of truly patient-centered, safe, high-quality care.