No mission<-->no margin: it's that simple

The authors describe their experience in developing a strategy-focused organization using the balanced scorecard methodology. They achieved this at Duke Children's Hospital by aligning the clinicians and administrators around a single integrated platform that linked improving business processes with achieving quality clinical outcomes. By organizing in this manner, they reduced cost by dollars 30 million and increased net margin by dollars 15 million while improving outcomes and staff satisfaction. This article describes a methodology to achieve strategic control of the organization, increase the knowledge of key stakeholders, and transform the organization to optimize the organization's performance.