Less than two decades after devolution, the Welsh health system remains a relatively young one; many of the institutions and mechanisms needed to promote high quality care are in place, but now a further push is needed to move towards a more mature, robust quality architecture. In many respects, “quality” is at the heart of the Welsh health system; this chapter describes Wales’ already-rich health care quality architecture. The ambition for an excellent, patient-centred health system, promoting quality, access and equity is clearly there in Wales, but now tangible practical steps are needed to make the necessary changes. This chapter makes a series of recommendations to support Wales in strengthening quality assurance and quality improvement. Assessment and recommendations are made across health system domains – from the role of accreditation and standards, to patient voice and professional training. Cutting across these domains, the priority should now be for Wales should be looking to increase accountability for delivering good quality and improving quality, and trying to establish some more concrete levers for positive system change.