As part of their landmark Keystone MHA project in Michigan ICUs (that previously demonstrated a 0% catheter-related bloodstream infection rate with adherence to a central-line bundle), Sexton, Pronovost et al also implemented the CUSP intervention to create a climate of continuous quality improvement and safety. Based on surveys of the staff in 71 ICUs, mean safety scores rose from 42.5% in 2004 to 52.2% in 2006, p<0.001 -- a significant increase, but still in the sub-60% "needs improvement" category and barely shy of the predefined 10-point meaningful difference. Crit Care Med 2011;39:934-939.