ELLEN J. GAUCHER is group vice president for operations/quality and customer satisfaction at Wellmark, Inc., Blue Cross and Blue Shield of Iowa and South Dakota. She is associate editor for Aspen's Quality Management in Health Care and serves as a board member of the Institute for Healthcare Improvement. RICHARD J. COFFEY, Ph.D., is director of program and operations analysis, and director of research and planning, at the University of Michigan Health System, Ann Arbor, Michigan. He has served in staff, consulting, and leadership roles in many university and community health care, consulting,