Purpose: This study aims to describe how the Army and the Army Medical Department matured as a learning organization (LO) during the period after the 2014 Military Health System Review through the incorporation of changes aimed at improving patient safety, data transparency and becoming a high-reliability organization (HRO). This study explores the relationship between HRO and LO concepts by adding to the body of knowledge in both disciplines. Design/methodology/approach: Four large-scale system changes are presented and evaluated against the principles of the LO. Metric data were collected longitudinally and presented as submitted to several nationally-recognized organizations in healthcare quality and safety. Post initiative observations are paired with a corresponding LO principle to assess US Army Medical Command's (MEDCOM's) maturation as a LO. System changes/improvements and the advancement of LO principles are discussed. Findings: System improvements, analyzed critically alongside paired LO principles, show strong correlation between high-reliability and LO principles. Despite inherent institutional barriers, this study demonstrates that, when leveraged effectively, the leadership hierarchy and command culture can accelerate transformation into an LO. Originality/value: This study explores changes implemented in MEDCOM, as it evolved as a stronger LO. It demonstrates how healthcare organizations and other high-risk industries that embrace high-reliability concepts will become better LOs and expands current knowledge on how LO concepts in healthcare can affect better system accountability and improved patient safety. Organizations can learn from MEDCOM's journey changes that can hasten progress toward adoption of LO principles, especially in hierarchical organizations.