This white paper presents a framework on which hospital leaders might build a written plan for physician engagement in quality and safety. The paper includes tools to help hospital leaders assess organizational factors that will inform the degree of difficulty in engaging physicians, as well as to identify and prioritize initiatives for which physician engagement is essential. While the principal focus of the paper is on American hospitals and their organized medical staffs, the framework might also be applied to many other types of health care systems and in settings outside the United States.