This monograph presents the December 9, 1999, “Escape Fire” keynote address by IHI President and CEO Dr. Donald M. Berwick at IHI’s 11th Annual National Forum on Quality Improvement in Health Care, in which he describes a 1949 wildfire that broke out on a Montana hillside, taking the lives of 13 young men and changing the way firefighting was managed in the United States. Dr. Berwick applies the lessons learned from this catastrophe to the health care system and outlines an ambitious program for reform, what Berwick calls an "escape fire," the term firefighters use for a deliberately burnt patch of land that, in an emergency, can provide refuge from an oncoming blaze.