Kingstree Health Network, a fictional rural healthcare organization, has recently implemented a network-wide project focused on developing a systematic process for discovering opportunities for improvement (OFI) and creating process improvement teams (PITs) to implement those solutions. Improving efficiency at Kingstree will require the establishment of process improvement strategies through forecasting and benchmarking, using evidence-based practices and applicable competitor analyses. Understanding industry standards, anticipating perceived growth, and other such challenging matters as employee and client satisfaction and instituting governmental change, all play a vital role in improving care delivery. This case invites students to methodically apply resource management techniques to achieve process improvements for overall operational efficiency when a health network discovers its Quality Improvement Department is unproductive and unengaged. Some of the general challenges surrounding the Quality Improvement Department include a culture with a lack of engagement by physicians and clinicians; belief that there are no problems to be addressed in most departments; resistance to change; limited use of big data; lack of ownership of issues; and defensiveness to others’ judgments and opinions. In the healthcare industry this is counterintuitive to improving quality.