Patient safety and quality are paramount at Lakeridge Health, in Durham, Ontario. The use of prospective analysis has provided us with the opportunity to understand systemic issues in a hospital organization and, as such, to implement sustainable changes that are meaningful to staff and will ensure an enhanced patient experience. To complement Accreditation Canada required organizational practices and a commitment to continuous quality improvement, Lakeridge Health has recognized how an inter-professional approach, staff engagement and use of quality tools support the focus on quality and safety. The implementation of best practices (both clinical and administrative processes) has been possible as a direct result of using this approach. This article outlines three case studies representing different applications of the prospective analysis methodology: ensuring safety with endoscopy processes, minimizing risk in narcotic administration and enhancing infection control practices. In each case, the methodology of prospective analysis was used to ensure the implementation of sustainable change that spans all sites in a multi-sited health facility. This article also includes lessons learned in an effort to understand and implement this quality methodology in healthcare.