Quality improvement (QI) raises standards of care, but it can also misfire by diverting resources, distorting behavior, and eroding the patient experience. This chapter examines unintended outcomes of QI, using the “Cobra Effect” to show how narrow KPIs can be manipulated and local gains can drive downstream harm (e.g., earlier discharge followed by higher readmissions). The chapter also clarifies common myths that weaken quality work, including: “small hospitals don’t need a formal quality program,” “the Quality Unit exists to find faults and punish,” “quality just means paperwork and doing everything by the book,” and “the Quality Unit only ticks boxes to meet procedures.” In place of metric fixation and compliance theater, we argue for a human-centric approach that pairs meaningful data with frontline judgment and patient voice. The result is improvement that sticks i.e., safer care, better decisions, and continuous learning without collateral damage.