We have many institutions that have successfully tackled the logistical, cultural, political, and practical barriers that have prevented systems like APACHE from playing a wider role in the daily management of patient care. The University of Michigan, Ann Arbor; Baptist Hospital, Miami, Fla; Munson Medical Center, Traverse City, Mich; North Shore Hospital, Long Island, NY; Dominican, Santa Cruz, Calif; and Long Beach Memorial Medical Center, Long Beach, Calif, are all great examples. In each of these institutions there is a dedicated and comprehensive team commitment to collect, interpret, and then act on the APACHE information received. In each institution there is also a combination of committed clinicians, and enabling technology monitors, identifies, and corrects shortfalls in quality using state-of-the-art methods and philosophy, that is, identifying best-practice standards and then moving toward them. In these efforts, one individual, Charles Watts, MD, University of Michigan, has greatly advanced the use of the APACHE system for process improvement and institutional advancement and deserves special mention.