Background The establishment of robust quality and safety (Q&S) best practices is crucial to ensuring patients receive the best care possible. As such, the University Health Network (UHN) is embarking on a Q&S transformation centered around the Institute for Healthcare Improvement’s (IHI’s) Whole System Quality (WSQ) framework.

Objectives The purpose of this project was to go beyond the published literature and glean behind-the-scenes strategies, approaches, advice, and lessons learned on the design and implementation of Q&S best practices from centres with preeminent international reputations in Q&S (see table 1), to inform our own and others’ respective Q&S transformations.

Methods Nine semi-structured open-ended interviews were conducted with leadership from centres spanning three continents. Questions centered on building infrastructure around Quality Planning (e.g., how did you develop and carry out your Q&S vision?), Quality Control (e.g., how do you effectively track and report Q&S metrics?), and Quality Improvement (e.g., how do you train and enable your staff to do Quality Improvement work?).

Results Inductive thematic analyses revealed common recommendations (see table 2) for Quality Planning (e.g., make Q&S the central focus of entire organization; reimagine Q&S governance structures that focus on quality in addition to safety including the creation a Chief Quality Officer position with a direct reporting line to the hospital President/Chief Executive Officer), Quality Control (e.g., apply advanced analytics that leverage artificial intelligence, and triangulate Q&S metrics with complementary datasets to drive change), and Quality Improvement (e.g., develop and grow Q&S champions at every layer of the organization).

Conclusions Our findings provide a blueprint for the successful implementation of the three IHI WSQ pillars. They serve as a conduit and call to action for the effective building of enterprise-wide Quality & Safety infrastructure with the potential for far-reaching downstream impacts on the quality and safety of care.