This document summarizes Scotland's national efforts to reduce patient harm and mortality rates in acute care hospitals between 2008-2015. Key points: 1. Scotland set ambitious aims in 2008 to reduce mortality by 15% and adverse events by 30% by 2012 through a system-wide strategy focused on reliability and implementation of safety bundles/checklists. 2. By 2015, Scotland achieved a 20% reduction in mortality, a 30% reduction in adverse events, and reliability of over 95% for safety processes through developing leadership, measurement systems, and testing improvements at local hospitals before spreading changes nationally. 3. Improvements included a 90% reduction in C. difficile infections, a 25% reduction in ICU