At the beginning of TCAB, many hospital leaders were skeptical that the work of testing and evaluating innovations could be widely spread. They expected that some high-value innovations would be identified on pilot units and that these would be widely disseminated, but that TCAB unit processes would not. During the first year of the program, attitudes changed, and there was increased commitment to spreading processes. Several things contributed to this change. The volume of tests convinced some leaders that the innovation work needed to be decentralized to reduce the burden on the units involved. Implementing some innovations required coordination across units or departments, and this required engaging staff in those units or departments in TCAB processes. Most significantly, there was a perception that the culture on the pilot units had changed and that the changes were desirable throughout the hospital. If the gains were to be sustained, hospitals believed, TCAB could not be viewed as a project that was going to end or be replaced by the next project, but had to be, in the words of a unit manager echoed among participating hospitals, “how we do our work.”