Exemplary quality scores at Luther Midelfort Mayo Health System in Eau Claire, Wis., are the result of a long-term commitment to building quality and safety into systems of care. Since joining the Mayo Health System in 1992, Luther Midelfort has advanced a culture that supports staff in their efforts to test new ideas and improve care. Although work focused on Centers for Medicare and Medicaid Services (CMS) core measures began recently, the newer efforts follow the philosophy and strategy established years earlier. In a recent analysis by The Commonwealth Fund, Luther Midelfort achieved the third-highest score in the country on a composite of 22 process-of-care measures that all hospitals report to CMS.