In 2010, The Joint Commission created accountability measures, evidence-based practices that produce positive impacts on patient outcomes. Each year, The Joint Commission recognizes Top Performers that provide more than 95% of their patients with recommended therapies for at least 3 accountability metrics. This article details Johns Hopkins Hospital's efforts to exceed the Top Performer award thresholds on multiple core measures. To realize this goal, the group developed a conceptual model that addresses the challenges accompanying quality and safety interventions. They also employed the Lean framework of define-measure-analyze-improve-control to help teams systematically create improvement plans. In addition, a monthly performance dashboard provided transparency and accountability. These efforts led to Johns Hopkins Hospital achieving a compliance goal of 96% or higher on 95% of the core measures in 2012. A previous AHRQ WebM&M interview with Dr. Peter Pronovost, the lead author of this paper, discussed the science of improving patient safety.