Health care quality, and its less desirable expression, patient injury, rightfully is a focus of public and private policy makers, providers, and patients. Important systems understandings have shown the culprit of error in a vast majority of patient injury. To emphasize and educate patients on their critical role in error reduction, some form of a 'health care partnership agreement' should be signed by both a provider representative and the patient at the outset of care. A foundation for an effective system of medical error disclosure requires an effective systems approach to error detection, analysis, and discussion. Aviation provides an analogy for this portion of a system of medical error disclosure. In formal policies and procedures within the facility, an 'error investigation team' should investigate any errors that lead to an adverse event. Through the use of mediation and open communications processes, it has been reported that settlement costs are reduced.