The Keystone ICU project gained noteworthy attention when it nearly eliminated catheter-related bloodstream infections across the state of Michigan. The study galvanized the effectiveness of checklists and the importance of fostering a safety culture. This retrospective follow-up study found that implementation of the Keystone project was associated with a significant decrease in hospital mortality compared to surrounding Midwest settings. However, the differences noted in length of stay were not statistically significant. The authors highlight how investments in large scale and robust quality improvement initiatives may not only reduce adverse events but also save lives. The senior author, Dr. Peter Pronovost, reflects on this work and other elements of his successful patient safety research programs in a 2010 book chronicling his career.