Introduction: While there are numerous reports in the literature of reduction of preventable harm events, sustainability to zero harm remains elusive with isolated approaches. We present our 10-year journey to patient safety by building a holistic scalable model to a culture of high reliability driven by transformational leadership, empowered frontline and patient engagement. Methods: We assessed our existing organizational culture of safety framework for NYU Langone Long Island Children’s services in 2014 and identified multi-tiered strategies for our 10 years culture transformation journey. Major key drivers included: designing programs to embed high reliability organization principles from leadership to frontline, data-informed governance, building Quality Improvement capacity and co-production with our patients and families. Central to our interventions are: 1. The Key Card Change Program - the program leverages the “kamishibai” lean management method to design visual cue cards as a tool for frontline and family partnership in the reduction of hospital acquired conditions (HACs) and driving highly reliable processes for safe care, 2. The deployment of our “people” bundle - HRO training, leadership methods and empowering our team with advanced QI capability 3. In alignment with the Children’s Hospitals Solutions for Patient Safety, ramping up utilization of proactive safety strategies for the past 2 years. Results: We have achieved > 70% reduction in hospital acquired conditions from hospital acquired infections, harms from falls and pressure injuries and unplanned extubations from 2014-2024. With scaling up of our HRO journey with proactive safety culture strategies, we are seeing an improvement in our Serious Safety Events rate for CY 2025. Conclusion:  Culture of Safety is an evolution, not a destination - by investing in our people to enable transformational leadrship and new competencies, co-designing solutions with our families and the frontline and leveling up approaches to proactive safety we have developed a scalable model towards achieving Zero harm.