SIOUX FALLS, S.D. -

The federal agency responsible for providing health care to Native Americans has unveiled a detailed outline to improve and then sustain the quality of care provided at its hospitals, some of which have faced longstanding deficiencies.
    
The efforts of the Indian Health Service's quality framework, which was released Wednesday, include hiring a deputy director of quality and cultivating an environment in which staff at all levels feel comfortable reporting medical errors and near misses.
    
Mary Smith is IHS's top leader. Smith, the principal deputy director, says the outline was developed with input from tribal leaders, national health care experts and the Department of Health and Human Services, which oversees the IHS.
    
Smith says the framework is a "living, breathing document" that will be reviewed and updated annually.