Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the potential for patient harm. During the past five years, Sentara has intensified and expanded the program by engaging the health system’s physician group and other operating units in efforts to: 1) encourage employees to be mindful of the signals of inadequate care and act on those signals; 2) provide leaders with concrete methods of reinforcing employee behaviors that enhance patient safety; 3) reinforce bulwarks against medical error by instituting processes for learning from mistakes; and 4) reward the attainment of high standards of performance. The initiative has helped to reduce the measured rate of serious safety events at Sentara hospitals by 80 percent over seven years.