Two hospitals in the Kettering Health Network--Kettering Medical Center and Sycamore Medical Center-- scored among the top 3 percent of U.S. hospitals on five surgical measures collected and reported by Centers for Medicare and Medicaid Services. The hospitals have made nurses key to their improvement strategy. In addition, they have focused on national quality initiatives, such as achieving Nursing Magnet status and the Malcolm Baldrige National Quality Award. The biggest change at the two hospitals in recent years was the introduction of concurrent quality monitoring and feedback to providers and managers. The use of real-time data has inspired competition and greater accountability among physicians and nurses, resulting in near-perfect compliance with recommended surgical processes.