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The purpose of this paper is to identify ways for organizationally complex, community‐based health improvement initiatives to avoid “failures” with regard to client outcomes.

Organizational research on errors, failures and high reliability organizations led Weick and Sutcliffe to articulate five strategies for organizational mindfulness: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise. Using this framework, one US federally funded health initiative to reduce infant mortality and pre‐term birth and a corresponding locally implemented program are analyzed. Experience with both over a five year period is the basis for this case study.

Mindlessness actions were found to occur at both the federal and local levels, despite the possibility of enacting mindfulness strategies at federal and local levels.

To create health care initiatives and programs in ways that prevent disastrous outcomes, such as infant death and preterm births, can be achieved through application of the mindfulness strategies.

The evidence‐based approach of organizational mindfulness previously has not been applied to health programs. Yet, this analysis demonstrates its usefulness in identifying ways in which these semi‐autonomous organizations could avoid “failures” for their program clients.