Spiraling medical costs, declining insurance reimbursement rates, skilled labor shortages, rising health care utilization by an aging population, and mounting consumer activism have been driving hospitals to adopt more methodologically rigorous management tools in order to evoke new efficiencies from complex health care operations. As Paul Mango and Louis Shapiro of McKinsey & Company argued in a 2001 report, hospitals are essentially a commodity business and therefore need to compete on the basis of operational efficiency. Critical to improving business performance is the availability of robust and timely performance metrics. The balanced scorecard, Six Sigma, and other in-house, metrics-based, quality management programs have been implemented by a growing number of health care organizations. Common to these programs is a more holistic approach to performance that recognizes organizational interdependencies, and in turn requires both nonfinancial and financial measures of performance.