The Unidade de Assistência Médica Ambulatorial (AMA) Jardim Pirajussara, located in the southern region of São Paulo, Brazil, is a pre-hospital care facility managed since 2016 through a public-private partnership between the Einstein Hospital Israelita and the Municipal Health Department. The unit performs approximately 14,000 monthly urgent and emergency consultations in Pediatrics and Internal Medicine, mostly low- and medium-complexity cases. This dynamic environment demands continuous strategic adaptation to ensure safety, efficiency, and clinical performance. In 2024, the unit initiated the certification process with the National Accreditation Organization (ONA), achieving accreditation in 2025. This advancement promoted structured governance, evidence-based protocols, enhanced training, and consolidation of a patient safety culture.PDCA management cycle was implemented to strengthen leadership, clinical performance, and organizational alignment. • Plan: Diagnostic assessment identified disruptive behavior, technical errors, low adherence to leadership, and communication issues. An Ishikawa diagram identified root causes across workforce, methods, environment, materials, and leadership. • Do: Actions included individual action plans (PAI), structured feedback, continuous dialogue, ethics and clinical training, and institutional initiatives such as the “Medical Records Reminder Project.” • Check: Indicators monitored included ≥95% compliant medical records, ≥95% protocol adherence, 90% reduction in prescription errors, ≥90% training participation, medical turnover ≤10% per year, and NPS improvement from –18.2 (Apr/2024) to +40.7 (Oct/2025). • Act: Interventions included procedure standardization, reallocation or dismissal of professionals posing care risks, revision of scheduling criteria, active listening groups, continuous audits, and reinforcement of reminder projects.ONA auditors recognized the initiative as original and bold, highlighting the innovative application of classic quality tools focused on clinical leadership and performance improvement.PDCA cycle effectively addressed technical, behavioral, and relational challenges. Its structured approach strengthened leadership, supported evidence-based practice, and improved professional engagement, illustrating its potential as a strategic governance tool.Integrating ethical, technical, and behavioral components, PDCA contributed to culture transformation, error reduction, team cohesion, and alignment with institutional values through tools such as Ishikawa analysis, structured feedback, and mixed indicators.Implementing PDCA at AMA Jardim Pirajussara demonstrated its utility as strategic clinical governance mechanism. ONA certification evidences structural and procedural improvements that sustain patient safety and high-quality care.