The health care industry is undergoing profound change and is growing increasingly complex. There is a need for performance improvement in health care organizations, even those in rural communities, to adapt to changing market forces that are moving payment structures from fee-for-service payments based on volume to one that is focused on value. This change also impacts health care delivery models and is defined by improved health, better care, with smarter spending. This perspective is driving changes in the health care system at all levels. Performance improvement seeks opportunities to reduce costs, improve quality and improve the health of patients and the community and monitor whether those opportunities are being successfully addressed. A variety of tools and processes are available to help organizations improve their strategic, financial and operational performance.