Under pressure to improve performance on indicators of financial well-being, patient satisfaction, and clinical quality, St. Mary's Health Center leadership made a deliberate decision to focus on Centers for Medicare and Medicaid Services process-of-care measures, or "core" measures. They set in motion a series of activities that resulted in striking improvement. The main strategies were: clear communication of the new directive by the hospital's president and Board of Directors; physician-led committees taking responsibility for performance improvement; intensified efforts to standardize clinical processes through order sets; dedicating a full-time staff member to data abstraction and initiating a system of concurrent and post-discharge review of medical charts; continuous measurement and analysis of performance data; providing feedback to staff; and sharing successes, lessons, and tools across hospitals in the health system.