(Originally published by The Governance Institute in May 2018.) Hospital and health system performance is, or should be, at the top of the agenda for every healthcare board in the U.S. The optics on performance almost always manifest as a scorecard that is owned by the board. Most, however, fail to account for what may be the most important ingredient in the recipe that produces high performance: culture. In part two of this two-part series, Daniel K. Zismer, Ph.D., and Ben Utecht support the claim that a culture of high performance in organizations can exist and provide a framework for board discussion.