There are a range of laws and regulations in Italy that in various ways address quality of care to ensure effective, safe and patient-centered health service delivery. The devolution of power to regions has, however, resulted in a range of quality initiatives at regional level: some regions have very well developed approaches towards the systematic measurement and management of quality improvement while other regions still have rather weak quality governance models. The challenge for Italy will be to achieve a more comprehensive and uniform approach towards quality monitoring and improvement throughout the country. Some steps have already been taken in this direction, but more could be done to guide all regions towards the robust quality improvement for the health system. A stronger central role for the Ministry of Health and/or its agencies (such as AGENAS), the development of more robust inspection functions to monitor minimum levels of care and patient safety standards are key priorities. Efforts are also needed to develop a stronger information infrastructure which, used appropriately, can contribute to quality improvement efforts. Data should be used more effectively as part of ongoing initiatives around performance monitoring of both health providers and health care facilities. A strategic focus on increasing patient involvement is also needed to steer more systematic quality improvement. 1