At one time, St. Charles Hospital in Port Jefferson, N.Y., was ranked in the bottom quarter of New York City metro area hospitals. But in 2004, St. Charles began a dramatic turnaround, particularly evident in its improved processes for minimizing surgical complications. This Commonwealth Fund case study, which is also available on WhyNotTheBest.org, examines how the hospital achieved its impressive quality improvements. WhyNotTheBest.org is the Fund's quality improvement resource for health professionals.