This article describes two initiatives from the National Patient Safety Agency, which were developed to address important areas of harm to patients. This harm stems from failing to recognise or respond appropriately to deteriorating patients and errors in pre-operative and peri-operative care of surgical patients. Both initiatives used principles of standardisation, reliability and human factors to develop tools and checklists to improve patient safety, with a common approach to supporting implementation. The article describes further advances and developments aimed at increasing and sustaining improvement, including the use of technology to reduce human error.