Introduction: The implementation of the Midline insertion program at the VA hospital was a transformative journey driven by a commitment to patient-centered care and a desire to establish a culture of reliability. This program aimed to optimize intravenous access, improve patient outcomes, and enhance the overall quality of care. By incorporating the three pillars and five principles of a high-reliable organization, the approach adopted for this journey was comprehensive, collaborative, and focused on continuous improvement. This abstract provides an overview of the program, highlights the journey of starting it up at the VA hospital, and shares the results achieved through this endeavor. The Midline Insertion Program: The Midline insertion program was designed to address the need for enhanced intravenous access techniques at the VA hospital. Midline catheters, longer peripheral intravenous devices, offered an alternative to traditional central venous catheters, providing several benefits such as decreased complications, improved patient comfort, and increased efficiency. The program aimed to optimize the insertion techniques, ensure proper education and training, and establish a culture of excellence and reliability surrounding Midline insertions. The Journey of Starting up the Program: The journey of starting up the Midline insertion program incorporated the three pillars of a high-reliable organization: leadership commitment, culture of safety, and robust process improvement. The leadership commitment was evident from the outset, with hospital leaders recognizing the importance of improving intravenous access and supporting the program's implementation. This commitment was instrumental in securing the necessary resources, engaging stakeholders, and fostering a culture of excellence. Creating a culture of safety was an integral part of the journey. The program emphasized open communication, shared decision-making, and continuous learning. The healthcare team was encouraged to report near misses and adverse events related to Midline insertions, fostering a culture of transparency and accountability. Regular safety huddles and debriefings were conducted to identify and address any potential risks or barriers to safe practice. Robust process improvement methodologies, aligned with the five principles of a high-reliable organization—preoccupation with failure, sensitivity to operations, reluctance to simplify, deference to expertise, and resilience—were employed throughout the project. The team conducted a thorough analysis of existing practices, identified areas for improvement, and implemented evidence-based strategies to enhance the Midline insertion process. This approach ensured that the program was continuously refined, addressing both short-term challenges and long-term sustainability. The Results: The implementation of the Midline insertion program yielded significant results. Patient outcomes improved, with a decrease in complications associated with intravenous access. The team observed a reduction in catheter-related bloodstream infections and instances of catheter displacement. Patient satisfaction increased as the program focused on promoting patient comfort and minimizing pain during the insertion process. Healthcare providers reported enhanced confidence and proficiency in performing Midline insertions, resulting in improved efficiency and reduced procedure times. The program's success also extended beyond the immediate outcomes. It fostered a culture of excellence and reliability within the hospital. Healthcare providers embraced the principles of a high-reliable organization, actively engaging in continuous learning, open communication, and collaboration. The team demonstrated resilience in overcoming challenges, adapting processes, and sustaining improvements. Conclusion: The journey of implementing the Midline insertion program at the VA hospital exemplified the organization's commitment to patient-centered care and excellence. By incorporating the three pillars and five principles of a high-reliable organization, the program team established a culture of reliability, safety, and continuous improvement. The results achieved through this journey were evident in improved patient outcomes, enhanced provider confidence, and a transformative shift in the hospital's culture. The Midline insertion program stands as a testament to the power of collaboration, leadership commitment, and the pursuit of excellence in healthcare.