Dr. Donald Berwick writes this compelling piece as a personal reflection on the current deficiencies in healthcare quality. As he prepares for a knee replacement, he defines five dimensions of total quality that he believes every patient deserves when receiving care at a healthcare institution. The dimensions are no needless deaths, no needless pain, no helplessness, no unwanted waiting, and no waste. The author discusses each of these dimensions and shares numerous anecdotes and analogies to vividly illustrate his points. He fears that no institution can meet his criteria today but points to the future of change that is required.