VitalSmarts® Crucial Conversations™ general program theory might be a possible countermeasure addressing organizational culture and communication factors affecting quality and safety. This practice inquiry reports: a VitalSmarts® Crucial Conversations™ general program logic model, a major medical center's Crucial Conversations™ historical implementation program logic model, a clinical exemplar central line associated blood stream infection program logic model; and, findings that describe the fidelity of the major medical center's Crucial Conversations™ historical implementation and clinical exemplar central line associated blood stream infection program logic model to the VitalSmarts® Crucial Conversations™ general program logic model. The results demonstrated there was no fidelity between the major medical center's Crucial Conversations™ program logic model and the VitalSmarts® Crucial Conversations™ general program logic model. The clinical exemplar CLABSI program logic model and VitalSmarts® Crucial Conversations™ general program logic model fidelity differed in intended outcomes. The results might suggest that program adaptability along with program fidelity are factors that influence program strength, and these factors must be uniquely balanced within organizational dynamics to realize intended outcomes. The formative evaluation and program logic model might be a feasible methodology and applicable tool for exploring quality and safety within complex adaptive systems, such as organizational culture, where constraints possibly could exclude more rigorous scientific methodologies until factors are more understood.