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Quality improvement (QI) directors hoping to win support for ambitious pay-for-performance (P4P) programs should start small with projects that will bring them early victories, advises Skye K. Schulte, director for HealthGate Data Corp. in Burlington, MA. "You really need to be successful right out of the starting gate," she says. "Even if you have to start off small on one or two quality improvement programs, it's better to do that and build a lot of positive support than to try to do too much and fail at everything."