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A steady stream of high-visibility medical accidents keeps patient safety on the front page of health care. Controversy about the exact size of the medical error problem continues, but there is little debate about the enormous opportunity for improvement in the safety and reliability of health care. Anesthesia-related deaths have declined from as many as 50 to just 3.4 per million inductions. This level of reliability is on par with the best safety records in other industries and far below those in the rest of health care. Achieving such a level of safety across health care will require considerable effort on the part of health care delivery systems and integration of physicians into such efforts. Indeed, the relationships between physicians, health delivery organizations, and patients lie at the crux of efforts to implement measurable improvements in patient safety.Previous experience of physicians' quality improvement efforts at delivery organizations and the current chaotic evolution of physician—health care delivery system relationships hold little hope for significant improvement in safety. The authors propose a new model of an organizational approach to safety and quality that can be used to accomplish these goals, and outline recommendations for the health care system to begin to alter the relationship between physicians and delivery systems to improve patient safety.