QUALITY in healthcare is defined by the patient centered results achieved through application of evidence based medicine creating a consistent reduction in unnecessary clinical variability. This process requires a dedicated commitment to performance improvement, interdisciplinary transparency, and an enhanced structure in patient safety to identify pertinent opportunities. The major focus of quality at CIRQLE involves the improvement of patient outcomes through creation of patient centered clinical themes. CIRQLE focuses on the harms created by hospital immobility, protection from the development of inpatient sepsis via iterative investigation of bloodstream sterility at all points of patient access, and the use of national databases, research trials, and benchmarks to evaluate actual performance. Efforts led by residents in collaborative teams have been presented at national conferences including reduction in blood culture contamination, integration of academic providers into daily mobility efforts, and evaluation of the potential harms of electronic alerting systems in sepsis identification. CIRQLE will continue to collaborate with national leaders in best practice and is quickly becoming a leader in the approach to healthcare quality.