...From a credit perspective, a not-for-profit hospital s focus on a quality agenda can translate into improved ratings through increased volume and market share, operational efficiencies, better rates from commercial payers, and improved financial performance. Like many strat egies, we recognize that realizing financial returns from a quality strategy may require large capital costs and incurred operating losses in the short term. However, over the long-term, a hospital s focus on quality will be viewed as a credit posit ive if greater patient demand and financial improvements materialize. Many not-for-profit hospitals are launching strategies to improve evidence-based clinical outcomes and patient safety, which we view as the two key facets of a strategy aimed at improving quality. The effort to improve quality is a major component of most hospitals mission to pr ovide the best patient care possible. For others, an agenda focusing on quality is driven by the increasing...