Continuous QI requires our hospitals to undergo a fundamental change in values, beliefs, and ways to manage. Process improvement changes must start with senior managers, who create the environment for continuous improvement and then enable department managers and employees to improve their processes. Persistent poor quality does not respect organizational boundaries, and HQIP provides an opportunity to manage all the resources necessary to make improvements. As pharmacy managers, we must identify processes under our control that can be continuously improved based on documented customer judgments. We must stop asking employees to work harder in a flawed system and empower them to improve those processes within their control. It may be easy to become frustrated if it seems to take a long time to implement TQM. Remember, transforming our departments and hospitals will not happen overnight. We are embarking on a new style of leadership and management, one that will help pharmacies implement our pharmaceutical care vision.