In 1994, ACOG published "Quality Assessment and Improvement in Obstetrics and Gynecology", which joined a long line of publications developed by the College to inform and assist Fellows who participate in peer review and quality improvement activities. This revision, "Quality and Safety in Women's Health Care", is intended to serve as a primer for obstetricians and gynaecologists starting or managing quality improvement programs within their hospital departments or ambulatory practices by focusing on the following areas: quality and safety in the inpatient setting; clinical competence; quality and safety in the outpatient setting; and, data analysis tools. The manual is presented in five parts. Part 1 provides background information on the evolution of health care quality improvement efforts. Part 2 provides an overview of quality and safety in the inpatient setting, including quality measurement, disclosure of adverse events, hospital leadership roles in community hospitals and residency programs, and patient safety initiatives. Some information may be adapted for use in the ambulatory setting. Part 3 addresses the issues of assessing clinical competence, one of the key elements of any quality improvement program and certainly a major responsibility for chairpersons of obstetrics and gynecology departments. Part 4 addresses quality and patient safety issues in the outpatient setting. Part 5 covers tools that can be used to analyze data or study management issues. Provided in the appendixes are resources that include the 2009 Report of the Presidential Task Force on Patient Safety in the Office Setting and the World Health Organization's Surgical Safety Checklist. It is hoped that this publication will complement the guidelines, practice bulletins and committee opinions from the college and jointly serve as the foundation for continuous quality improvement and evidence-based best practices in obstetrics and gynecology.