Promoting physician engagement in work to improve the quality and safety of care is critically important, but an ongoing challenge. This qualitative study conducted site visits and semistructured interviews to describe thematic strategies for physician engagement at 10 high-performing hospitals. The authors developed a six-point framework to highlight best practices, which included engaged leadership, a physician compact, appropriate compensation, realignment of financial incentives, clinical data, and ties to promotion. The largest barriers to engagement were lack of time and institutional culture. A past Joint Commission Sentinel Event Alert focused on leadership as a key component to fostering a culture of safety and promoting provider engagement.