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Although government studies indicate that financial incentives associated with pay-for-performance programs improve quality, some hospitals are finding ways to use public transparency and physician performance reports to drive change in their facility. Rather than forcing unproven quality indicators on a reluctant medical staff, Norton Healthcare, a five-hospital system in Louisville, KY, partners with its physicians to improve the indicators and develop processes for improving quality in those measurement areas. "One of the keys is getting the one-on-one involvement of physicians," says Steve Hester, MD, vice president of medical affairs for Norton Healthcare.