More than a decade ago, the board of directors and executive leaders of Virginia Mason (VM) Health System in Seattle, WA, held a series of meetings to determine the future direction of the organization. It was a new century, we had a new CEO, and the Institute of Medicine report Crossing the Quality Chasm had just been published. We knew we had to make fundamental, even radical, changes in how we managed the medical center. We focused on three things: 1) the safety of patients while in our care; 2) the quality of the care we provided; and 3) the cost of delivering care. These three elements were, we knew, inextricably tied together. We would have to concentrate on all three to make Virginia Mason the place we knew it could and should be.