The Institute for Healthcare Improvement (IHI) developed A Framework for Safe, Reliable and Effective Care to provide clarity and direction for healthcare organizations on the key strategic, clinical and operational components involved in achieving safe and reliable operational excellence. The white paper describes the framework’s culture and the learning system, and provides definitions and implementation strategies for nine interrelated components: leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement, and continuous learning. It also discusses engagement of patients and their families. The framework is applicable for acute care, ambulatory care, home care, long term care and community-based care settings.