Foster poses a fascinating dilemma when he asks the question: Would you admit your mother to the residency service? (1) It is fascinating not least because it causes us to reflect on our attitudes to patient centredness. Put bluntly, if we would not admit a family member to the residency service, then why would we admit any patient to this service? Foster's perspective is also telling when he describes the behaviour of most physicians when one of their family members is admitted to hospital – they become the ‘shadow attending’ – ensuring that everything is done in the safest and the most evidence-based way. Unfortunately, having a ‘shadow attending’ for all patients would bankrupt the health service – we need to think of ways of ensuring that all patients receive the best possible care. How will we do this without making healthcare impossibly expensive?The answer may lie within the quality improvement movement. The first step in improving the quality of care is recognising that it is not as good as it could be and that it could be improved. Training residents in quality measurement techniques is therefore likely to be wise. And measurement is not just something that should be done at the start and end of a project – rather residents should understand the importance of continuous measurement as a driver for quality. After that, we should move away from the narrow thinking that there will only be one way to improve quality. Clinical interventions will be best in certain circumstances – in other circumstances, educational interventions will be better and sometimes methods from improvement science will be most appropriate. Whatever the methods used, we should also think of quality improvement as a team activity. Care is increasingly delivered in teams in all specialities – so quality improvement should happen in teams also – and ideally in interdisciplinary teams. Rather than trying to impose quality targets from the top, it might be best to listen to residents and hear what they have to say about interventions to improve quality. Perhaps, most importantly, we need to value quality improvement activities amongst our residents. If residents see that quality improvement is perceived as a worthy endeavour but that the real rewards go to those who are involved in biomedical research or hospital management, then they will simply not take quality improvement seriously. We need to envisage a future where all applicants for senior specialist posts will be expected to have a section of the curriculum vitae describing their experience in quality improvement. Then we are much more likely to have residency services where we would be happy to have all patients cared for.