Over the past two years Barnes-Jewish Hospital has used Lean and Six Sigma methodologies in process improvement projects to prevent inpatient falls and falls with injury. These intensive programs have validated that falls are a multifaceted, complex problem that need constant vigilance and continuous improvement to sustain patient safety. Falls that result in serious injury can be life-changing for patients and families as well as impact the caregivers with potentially severe financial and health consequences. Trends in fall rates after completion of two Case Studies show that while decreasing the number of falls continue to be a challenge; the severity of injury from a fall can be reduced with patient and staff collaboration.