© 2018 The Joint Commission Background: Application of high reliability principles has the potential to transform the health care industry to perform with a higher level of safety than is present today. The purpose of this study was to quantitatively assess and describe the extent and variability of integration of high reliability practices among a collaborative of children's hospitals using the High Reliability Health Care Maturity (HRHCM) model. Methods: A survey instrument based on the HRHCM model was developed to determine the extent of integration of high reliability practices across hospitals participating in the Children's Hospitals’ Solutions for Patient Safety (CHSPS) network. The survey was distributed with instructions for completion to obtain a single organizational response, which was then used to quantify the extent to which high reliability attributes were implemented at each organization. Results: Of the 95 institutions in the CHSPS at the time of the study, 46 provided a complete response to the survey (48.4% response rate). The overall mean score for high reliability was 42.3 (range: 28–53), which places the cohort in the stage of approaching high reliability. Of the responding organizations, none fell into the beginning stage, while 15.2% landed in the developing, 4.3% in the advancing, and 80.4% in the approaching high reliability stages. Conclusion: Understanding high reliability attributes and assessing the location of individual and collaborative-wide sites along the high reliability continuum using this maturity model identify opportunities for organizations as they progress on their high reliability journey. Our results suggest opportunity in all domains of the high reliability maturity model for the majority of participating children's hospitals.