An uncomfortable truth about US health care is that medical harm and needless deaths continue to occur, even after a decade of concentrated efforts to eliminate them. However, some hospital systems are managing to improve patient safety. Legacy Health, a system with six hospitals in the Portland, Oregon, metropolitan area, engaged its entire workforce in an initiative to reduce rates of infection and mortality. Legacy staff used bundles of best practices to prevent four common health care–associated infections; reviewed deaths and revised procedures based on the findings; and included staff from different disciplines in daily medical rounds. The results were a 44.6 percent reduction in infections and a 13.5 percent reduction in mortality, as well as annual savings of more than $6.8 million for each of the first two years from the avoided costs of treating health care–associated infections. Fewer patients suffered, died, or incurred daunting copayments for hospital care. These results demonstrate that health care systems can greatly improve quality and safety and lower costs when leaders as well as front-line clinicians and staff are highly involved in improvement efforts.