Exhaustive research documents the fact that today in America, there is no guarantee that any individual will receive high-quality care for any particular health problem. Health care is plagued with inappropriate utilization of health services and errors in health care practice. The quality and safety of health care in this nation were assessed through a series of 11 reports from the Institute of Medicine (IOM). Some of the most significant components of the first two reports are a set of aims to achieve high-quality care and new rules to guide the redesign of the broken health care system. The needed transformation and steps to achieving redesign are substantial because the chasm between what currently exists in health care and what should exist to achieve high-quality care is sizeable. While only four of the IOM reports will be discussed in this section—other reports are discussed in other chapters later in this book—each has significant implications for nursing and for how care should be delivered. In 1999, the IOM released its landmark report, To Err Is Human: Building a Safer Health System. The chilling conclusion of that report was that thousands of people were injured by the very health system from which they sought help. Tens of thousands of Americans die each year and hundreds of thousands are injured. That report and its companion, Crossing the Quality Chasm, have had a profound impact on how health care is viewed. The information and perspectives moved conversations regarding patient safety and quality care from inside health care institutions to the mainstream of media, corporate America, and public policy. The reports raised awareness of the depth and complexity of quality challenges and prompted the marked expansion of quality improvement efforts through research and other means. The most significant barrier to improving patient safety identified in To Err Is Human is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations. This lack of awareness exists because the vast majority of errors are not reported, and errors are not reported because personnel fear they will be punished” (p. 155). While these statements describing the essence of the challenges facing health care are simple and straightforward, the level and complexity of effort needed to address them is not. Since the release of the two reports, broad-based efforts have begun to bring more sophistication and precision to measuring and improving the safety and quality of health care. Nevertheless, substantial work in both academic and practice settings remains to be done. While the IOM reports initiated tectonic shifts in attention and effort, the reports were not the first set of clear statements of concern regarding safety and quality. Nor were these reports the first efforts at calling attention to the need for data, public reporting, and the consideration of health care quality in light of payment for care. More than 140 years earlier, Florence Nightingale, the founder of modern nursing, raised these same issues. In spite of the passage of well over a century between Nightingale and the release of the IOM reports, seemingly little attention was paid in the interim to creating safer health care environments.