Why do most improvement efforts seem to fizzle out? Why are they not sustainable? Something has been missing from the strategy, planning, and implementation of these quality efforts. That missing ingredient has been culture. This book provides the strategy, tools, and methods needed for sustainable quality. e book is based on a new quality model and explains why a positive culture is a prerequisite to sustainable quality improvement. Excellence is achieved through people, and it is this people-centric approach that should be the basis for success. By building a foundation based on inclusion, positive culture, and strong leadership, great achievements are possible. is inside-out approach creates a strong internal community which can be the catalyst for embracing change and sustainable improvement.