In this issue of CHEST (see page 56), Wayne and colleagues1– provide us an opportunity to reflect on a rather astounding aspect of what we believe will be the norm in health-care training. At one level, this article describes an educational process that was instituted to train team members (medical residents) in advanced cardiac life support (ACLS), which in turn led to a measurable and significant positive impact on real-world clinical performance standards. A more thorough look at the article, however, reveals something rather extraordinary, namely process engineering principles being applied to health care and facilitated by the medical simulation facility (functioning as the clinical safety and quality research laboratory of the institution); the result was a measurably safer patient environment. This finding, although astounding to some, is certainly not without precedents among other high-risk industries, such as aviation and chemical engineering.2–3 In truth, this process is part of a quality revolution that is occurring within many health-care institutions. Let’s look further.