Improving safety in health care organizations requires commitment from senior leadership and governance. It also requires an organizational structure that facilitates identifying and addressing safety issues. This study describes the organizational structure used at Johns Hopkins Medicine to prioritize improving quality, safety, and value. The organization developed a reporting and oversight framework using four key principles: governance from the hospital board's dedicated patient safety and quality committee, shared accountability between the board and clinical leadership, a consolidated quality performance statement to ensure transparency around goals and priorities, and internal audits to ensure reliability and accuracy of safety and quality data. The authors provide examples of how this framework was used to address safety issues such as health care–associated infections. An earlier article described Johns Hopkins' success at achieving consistently high performance on accountability measures.