Home-based care providers have been challenged to employ lean principles and create a staff-driven culture because of a dispersed care settings and a remote workforce. For one Home Health, Hospice, and Home Infusion program, a quality and organizational culture system built on a commitment to zero harm model is helping them reduce all harms and simultaneously increase staff retention. The fundamental goal of their model called Commit to Zero Harm is real-time problem solving to manage risk of harm to patients, their loved ones, and each other. Components of the program include 15-minute tiered huddles, escalation pathways, intense leadership engagement, and shared learnings. This agency is now seeing significant improvements in key safety and performance metrics. Some areas of improvement include increased retention rates up to fifty percent, more timely patient access to care, and other safety performance outcomes.