The corporate Leader-Employee Activities Performance (LEAP) Office tracks and oversees improvement projects systemwide, with one APEX quality coordinator (who either is an RN or has a quality credential) housed at each facility. To design systems and make simple improvements, teams use Plan-Do-Check-Act (PDCA). The LEAP Office runs a Lean Six Sigma (LSS) program (created in 2009) for more complex improvement projects as well as a Yellow Belt training and certification program. These approaches work together under the system’s overarching performance improvement system, the Baldrige framework. TL began its performance excellence journey in 2001 with the submission of a Bronze-level applica-tion for the Baldrige-based USSN/ALC Excellence Award. TL also participates in the Union of U.S. Nurses’ (UUSN) Voyage to Distinction and Gemstone Designation Program.