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Lead or follow? Hospitals have long relied on a straightforward formula of clinical care, patient service, efficiency, and top-down decision-making to help generate positive financial results and impact in the community-at times with variable outcomes. Historically, quality has gotten lost in the shuffle, but quality is the key driver behind increasing growth. Good service relies on the high quality of staff and the resources available to them. Efficiency depends on the good quality of operational processes. Decision-making rests on the high quality of available information and the leadership.