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Purpose – To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.

Design/methodology/approach – A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.

Findings – Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.

Research limitations/implications – Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.

Practical implications – If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.

Social implications – Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.

Originality/value – The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.