Creating this type of a program is a challenge and takes the time and commitment of key players. Most healthcare facilities have had systems and processes in place for years to "ensure quality." Inherent in those systems has been some ability to detect errors and to identify opportunities for improving quality of care. The next evolution of ensuring quality requires healthcare organizations to become far more proactive with error detection and correction systems. How? Becoming more openly and honestly communicative internally is an important first step. That means creating a nonpunitive environment that encourages staff members to report known or suspected problems. To do this most successfully requires not only involving members of the hospital staff who become aware of concerns, but also engaging patients and families as partners in the process. Healthcare organizations can learn much from patients and families about things that actually or almost go wrong. In turn, healthcare organizations owe patients and their families honesty when they know something has gone wrong that could or should have been prevented. Many healthcare organizations throughout the country are struggling with these new expectations from accreditors and consumers about disclosing medical errors to patients (and/or their families). Some may still even be questioning the need and/or the value of doing so. The Lexington VA Medical Center has been disclosing errors for approximately 10 years. The center has also been piloting proactive approaches to identifying and eliminating threats to patient safety (i.e., error-prone systems and processes). VAMC's experiences have demonstrated that both are clearly worth the effort.