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Richard Bankowitz, MD, Premier's chief medical officer, says the project accepted hospitals only if they agreed to several key points:

• Senior leadership needed to pledge commitment through the process and remove barriers
• To be transparent with their data, which meant all 157 hospitals could see each others' performance
• To which measures to use and to define what success would look like
• To share best practices with each other

It wasn't easy. EAMC's Hubbard says that in talking with other hospitals, he learned some "didn't join Quest because they were afraid they would look bad on paper and didn't want anybody to know. So it was a real leap of faith by our administration to let us be a part of this. It helped physicians learn to look at results that always as good as we would like."

"Change is more difficult for some people than others, particularly if we're convinced that the way we have always done it is just fine and we don't see the needs in our own patient population, because we haven't stepped away to look at the big picture," he says.

Premier is continuing the project for another three-year period, calling it Quest 2.0, and is raising the benchmarks for many of the quality measures needing improvement. It is encouraging hospitals to sign up.