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The 2000 release of To Err Is Human instigated a series of IOM reports that provided eye‐opening data on the profusion of defects in health care and heralded ways to improve the system of care. Perhaps most shocking was the estimate that 44,000–98,000 people died each year due to preventable health care harm. Before the 1999 report, preventable harm was cloaked in silence; mistakes were hidden without discussion, patients were informed only when absolutely necessary, and workers were blamed and punished for mistakes. Before the 1999 report, we lacked evidence to determine the scope or depth of system issues that contributed to poor quality and safety outcomes because we lacked local and national reporting systems. To Err Is Human sparked action that gradually brought pressure from regulators, health care purchasers, third‐party payers, and consumers to improve quality and safety outcomes.