Accreditation of healthcare organizations using generic healthcare standards and more recently diving deeper into the delivery of services is considered by many as an initial way towards excellence. However, without a systemic and systematic approach to organizational learning, many opportunities can be lost and necessary changes slowed down. Not so long ago I read a story of people shouting for help when a wild river was draining them downstream. Three rescuers happened to be nearby. The first one, a stout and courageous man, jumped into the river and helped a drowning person. Comparing this to healthcare it looked like an urgent case needing immediate attention. The second rescuer thought that there were too many people in the water and that it would be more effective to have a boat thus attending to more people at once. The third one jumped into the water starting to swim upstream. “What are you doing? Why won’t you help us”? the second rescuer shouted at her. “I am trying to find out what is happening upstream and why these people are falling into the water.” It seems that both downstream and upstream approaches are the right things to do, at least at the present state of affairs in healthcare. Healthcare organizations are viewed as a complex system, as a live organism necessitating a constant change to survive and deliver high quality and safe care. Without a robust and integrated information-communication system, it is almost impossible to improve on a whole scale. Improvement efforts are often short-lived and therefore strong leadership is needed with the engagement of physicians, nurses and all other staff. If you are an “upstreamist” than the idea of organizational learning is not foreign to you. Organizational learning may be defined as a process of increasing knowledge and innovation of work routines with action and reflection going beyond individual-focused training (Carroll and Edmondson , 2002). Organizational learning involves continuous quality improvement (CQI) teams, improve collaboration, and healthcare reengineering works. Organizational learning may have different names, nevertheless, the process is generic. In the UK the term used is “Clinical Governance” The aim of organizational learning is to promote a culture of CQI made of clinical performance, internal and external clinical audit, clinical risk management, complaints, health needs assessment, practice based on evidence, continuous education, leadership, culture of excellence and distinct accountability. Everyone working in healthcare has been through specific training for his/her future profession. For quality improvement and patient safety, it is sometimes thought that no training and no competences are necessary as this is already imprinted in the human genome. The third prerequisite for CQI is leadership skills to promote the integration of competences and stimulate working together. Carroll JS and Edmondson AC. Leading organizational learning in health care. Qual Saf Health Care 2002;11:51-6.