Duke University Hospital is a 924-bed academic medical center in Durham, North Carolina. Scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey show that it is a leading hospital nationally on measures of patient satisfaction. Duke University Hospital leaders say that ensuring patient satisfaction requires both organizational and tactical strategies. Particular strategies include: commitment to improving customer service and work culture, and to leadership training; use of a Balanced Scorecard management tool; use of Six Sigma improvement methodology to address underperformance; and recognition of staff members and units demonstrating outstanding customer service.