Over the last 25 years we have learned how providers can fall short of their goals, and deliver care which is below expectations. In response, nations and the international community including the World Health Organization have developed strategies to tackle harm and improve the quality of care. Key approaches include strengthening management and leadership; designing improvement tools, models and approaches; enhancing teamwork, communication and local cultures; and leveraging opinion leaders and champions. A shift towards a systems perspective, factoring in the challenges of complexity and network characteristics, is evident. A safety-II approach, building on the naturally-occurring resilience of health systems, show much promise. But progress has been slow. We will need to be better at diffusing what we know works, scaling up localized, demonstrated successes, and supporting clinicians’ everyday capacities to succeed under varied conditions. Progress requires partnerships between politicians, policymakers, managers, clinicians, patients, researchers and other groups.