This study used interviews, direct observation of board meetings, and review of important documents to characterize how the leadership of 15 health care organizations in England approached quality and safety. The investigators identified a subset of organizations that explicitly prioritized quality improvement through use of data, engaging frontline clinicians and patients, and effectively balancing short- and long-term priorities. As board engagement and management practices have been shown to correlate with quality metrics, the best practices identified in this study may be important in the development of more effective organizational leadership around quality and safety.