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The important part is the action items are assigned an owner and executed.

I’ve done plenty of postmortems and many meetings where we go through the motions but “leadership” does not assign and address follow-ups. Most organizations pay lip service to reliability.

I agree. Finding the time to update docs, processes and code based on a post-mortem is, from my experience, the hardest part. Critical, but difficult.

Do the actionable items usually get implemented?

You can expect what you inspect - Peter Drucker

Action items need an a forcing feature (like an SLO) to insure they are picked up. And someone needs to follow up when the item isn't handled timely. It should show up in team performance metrics and guide changes to processes to insure they get done.

Actionable items go onto the backlog. The backlog grows from the top.

As a stopgap, a manual pre-flight check is added. The number of manual pre-flight checks becomes a ridiculous overhead but it gives a clear person to blame when something goes wrong.