While the executive team works to foster a culture of improvement and establish clear goals and metrics for the organization, the day-to-day execution is the responsibility of frontline managers who direct resources at the immediate levels of front end care. Getting frontline managers and their staff to fully commit to implementing the organization's plan is one of the most important elements in building a culture dedicated to sustaining improvement. These individuals help contribute to an atmosphere of mutual trust in which all staff members can talk freely about problems and seek solutions without fear.  As the most highly trained professionals regularly at patients' bedsides, registered nurses (RNs) play a central role in ensuring the quality of hospital care. The IOM documented this role in its 2004 report, Keeping Patients Safe: Transforming the Work Environment for Nurses. This presentation presents evidence based strategies that empower front-line staff to make changes in core processes and to sustain those changes over time.