The Partnership for Health and Accountability (PHA), a voluntary quality improvement and patient safety program, has focused on comprehensive evaluation and feedback. Shared reporting of processes and outcomes is the vehicle for internal quality improvement. PHA provides access to quality and safety tools and benchmarking resources for a diverse group of hospitals, including rural and critical accessfacilities. PARTICIPATION AND OUTCOMES: Hospital participation in PHA-sponsored programs has increased each year, with all eligible hospitals participating in at least one PHA program. Participants in the Safe Medication Use initiative have seen reductions in targeted medication errors, and 97% of the hospitals have reported their performance on Joint Commission on Accreditation of Healthcare Organizations core measures. Athens Regional Medical Center (315 beds) developed the Systematic Assessment of Flow and Error (SAFE) tool, which addresses patient information, clinical decisions, care processes, and patient flow, as a starting point for a wide range of quality improvement initiatives. Since 2004 Habersham County Medical Center, a small (53 beds), rural primary care hospital, has realized a decrease of more than 50% in the postoperative pneumonia rate and a significant decrease in surgical infection rates. PHA's challenge is to remain relevant, stable, and integrated and meet the needs of a diverse group of hospitals and yet remain flexible enough to evolve as systems and patient safety priorities change.