The most effective organizations, in terms of both quality and financial results, are led by senior teams with a shared sense of purpose and a collective vision of how to get there. In these challenging economic times, the urgency for an integrated and effective senior team is driven by both external factors and internal needs. In 2009 hospitals have had to cope with decreases in admissions, increases in uncompensated care and other key drivers for linking cost and quality. As quality and patient satisfaction data have become more transparent, insurers and employers are initiating more cost-conscious comparisons of cost and quality outcomes data in the search for higher value. Healthcare organizations are far more likely to achieve dramatic improvement in system-level metrics when the CFOs are strong proponents of quality improvement. Ensuring financial viability and improving care for patients should not be separate, compartmentalized responsibilities.