Child and adolescent psychiatrists in leadership positions need resources, support, and continuing education to build skills for effective medical leadership. This Workshop is the fourth in a series of programs designed for medical directors and perspective medical directors. It focuses on performance improvement, with emphasis placed on understanding process and microsystems, applying performance improvement principles to a case, and developing a plan for a specific performance improvement project. Through the use of specific cases, effective leadership approaches in the clinical care setting are illustrated; including patient violence, elopement, readmission rates, staff injury, and patient functional outcomes. Small groups are assigned a performance improvement project to determine an AIM statement and working plan for implementation and assessment. Participants are encouraged to share their leadership situation and candidly discuss their challenges.