Multiple reports have concluded that healthcare does not reliably meet patient needs and can even cause harm. The Institute for Healthcare Improvement (IHI) has adapted reliability principles and methods from other industries and applied them in healthcare with promising results in hospital settings. This article describes how one outpatient system successfully applied the IHI reliability methods to multiple clinical and administrative processes. How the application may differ in outpatient environments is also discussed. In particular, the patient role is much more central, and a strong collaborative engagement with the patient is likely necessary to achieve high reliability. Applying reliability principles to patient-centered processes is a critical and undeveloped area.