This chapter addresses the basic problem of improving emergency department flow and reducing trauma and dissatisfaction for consumers and staff alike. The Six Sigma system of improvement utilizes experts in the quality improvement process. The process begins with executive management commitment to the process and establishment of the organization's goals. The follow-up telephone interview assessed patient satisfaction with emergency department (ED) care, self-reported problems with the process of care, and discharge instructions. After reviewing the data on results and satisfaction, each hospital was allowed to organize its own quality improvement project. A number of efforts have been mounted to change ED systems of care. The atmosphere and culture in many EDs can actually, and inadvertently, encourage destabilization in people who appear with behavioral health problems. The Institute for Behavioral Healthcare Improvement (IBHI) is a not-for-profit organization dedicated to improving the quality and outcome of behavioral health care.