This challenging and highly practical book draws on the findings from an international study designed to help practitioners and researchers understand the factors and processes that enable healthcare organisations in the United States and Europe to achieve - and sustain - high quality services for their users. The in-depth case-studies from seven leading hospitals give an international, evidence-based outlook that focuses on both the organisational and cultural processes of quality improvement. Implication for research and practice are considered, and a checklist of possible challenges has been drawn up to help identify any 'gaps' in initiatives. Healthcare policy makers and shapers including hospital chief executives and NHS directors will find this book enlightening, as will healthcare quality improvement and service development researchers and professionals. Clinicians with an interest in quality improvement will also find much of interest.