Problems with health care are often a result of “system” failings. Continuous quality improvement (CQI) programs aim to improve the quality of health care by addressing these failings. The programs involve several steps. First, health care organizations identify what they want to improve. Second, they develop processes to address those areas. Third, they test the processes by monitoring performance and outcomes. If the processes improved quality of care, the health care organizations use them routinely and widely. If not, they refine and retest different processes. This cycle ideally continues until the organization achieves optimal performance. Although many organizations embrace these methods, few large studies test whether CQI programs actually improve quality of care.