Gundersen Lutheran Health System is a physician-led, not-for-profit integrated delivery system serving more than 550,000 people in Wisconsin, Iowa, and Minnesota. Gundersen Lutheran has increased efficiency, improved patient care, and achieved the high performance associated with large urban institutions by: 1) using clinical and financial outcomes to set benchmarks and targets for improvement, to increase transparency, and to drive improvement among physicians; 2) investing in primary care and disease management programs; and 3) hiring engineers to improve operations. It offers leadership training programs that encourage cross-training and partnership within the institution and uses external collaborations to improve community health and extend its models of care and service to outlying communities. Gundersen Lutheran’s physician compact outlines the organization’s expectations of physicians and ensures that its medical staff remains committed to the organization’s mission: to distinguish itself in patient care, education, research, and community health