Abstract
Evidence-based pain management, a high-volume hospital service, impacts resource utilization and quality indicators. Despite extensive efforts to improve care, outcomes remain poor, and barriers seem insurmountable. Change management strategies that embrace organizational and individual accountabilities are warranted. Conceptualizing evidence-based pain management within the context of high-reliability theory may help redesign systems and processes to better meet needs of patients. The author discusses using a high-reliability framework as a change management strategy.