High-quality, reliable safe health care is a complex challenge. This commentary reviews estimates of health care–associated harm and injury to patients and the complexities associated with the Centers for Medicare and Medicaid Services financial penalties approach to drive improvement.

The Veterans Health Administration faces a myriad of challenges to providing safe care. This commentary highlights the importance of using a systems approach to address problems rather than treating each issue as an isolated case. The authors recommend ways to improve the safety of VHA services, including creating new classifications for leaders, committing to a culture of safety, and improving interoperability of electronic record systems.