Delivering reliable health care requires deliberate designs to achieve the desired levels of reliability. This April 2005 presentation summarizes the reliability model and change concepts that IHI is using to guide 36 teams through the journey of improving reliability in five clinical areas: Acute Myocardial Infarction (AMI); Community-Acquired Pneumonia (CAP); Corornary Artery Bypass Graft (CABG); Hip and Knee Replacement; and Heart Failure (HF). This project is one of the IMPACT network's Innovation Communities.