More than half of hospitals in the United States belong to a multi-hospital system, accounting for the majority of all patient admissions. Recent data derived from the Hospital Quality Alliance measures that are publicly reported by Medicare show significant variability among these systems with respect to patient satisfaction, quality of care, and risk-adjusted mortality. But what is behind this variation? In this project, the research team will identify system characteristics and strategies that are related to better hospital system performance. The benchmark data produced for roughly 125 systems will be made available on the Fund's new Web site, WhyNotTheBest.org, as a resource for health care leaders seeking change within their organization.