Prior research has shown that malpractice risk in the outpatient setting is significant and that claims frequently involve missed and delayed diagnoses. This editorial describes lessons learned from the Massachusetts PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) project. Funded by the Agency for Healthcare Research and Quality, the PROMISES project involved a multipronged intervention within 16 randomly selected primary care practices to address known areas of risk in ambulatory care, including test result management, referrals, medication management, and communication issues. A previous PSNet perspective discussed how research may help improve the malpractice system.