The Institute of Medicine's 2001 Crossing the Quality Chasm report defined an agenda for improving health care quality in the United States and provided an important stimulus for ongoing quality improvement (QI) efforts in the inpatient and outpatient settings. This study, conducted 5 years after the IOM report, evaluated the extent and types of QI activities at a broad sample of hospitals by surveying hospital leadership. Hospitals are engaging in a wide variety of QI activities, targeting common safety problems such as hospital-acquired infections and medication reconciliation, and reported high levels of organizational commitment to improving quality. However, problems noted in prior research, such as lack of physician engagement in QI and limited use of information technology, continued to pose barriers to effective quality improvement.