The growing national focus on improving health care quality has placed new demands on hospital leadership to carry out quality improvement (QI) initiatives. In this qualitative study, the authors interviewed chief executive officers, chief medical officers, and board members at 18 community hospitals concerning their interest and involvement in QI activities. While hospital CEOs were familiar with QI terminology and recent developments, they felt that efforts to improve quality would become higher organizational priorities if they were supported by a more robust business case. Hospital governing boards were generally not involved in quality activities. A common theme voiced by interviewees was the need for greater physician involvement in QI efforts. A prior commentary discussed the need for dynamic leadership to tackle the challenge of improving health care quality, and a recent article reported that some hospitals' governing boards are now actively addressing quality issues.