Objective To describe the important distinctions between traditional biomedical and high reliability organisation (HRO) approaches in advancing healthcare delivery. To further describe how these two concepts can be integrated in a learning health system to improve care for patients, providers’ experience and healthcare organisations’ effectiveness.

Methods and analysis A description of how HRO and traditional biomedical approaches address problems in healthcare is provided, along with a description of their key characteristics. This is followed by a discussion on how to combine these concepts synergistically to the benefit of all stakeholders in a learning health system.

Results Health systems are challenged to become learning health systems but the path toward this goal is not well described, particularly on how to integrate existing approaches.

Conclusion HRO and traditional biomedical approaches are important strategies to improving healthcare. However, they fundamentally address the challenges in healthcare differently. It is important to find ways to integrate these concepts to achieve maximum benefit in a learning health system.