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The purpose of this Golden LEAF grant is to support the Eastern NC Rural Hospital Lean Improvement Collaborative. This partnership, consisting of five rural hospitals, will implement Lean Management principles to eliminate waste and reduce errors while improving quality, efficiency, performance, and care, and enhancing rural hospital sustainability. The Collaborative includes Sampson Regional Medical Center, Vidant Duplin Hospital, Dosher Memorial Hospital, Johnston Medical Center and Columbus Regional Healthcare System. The five hospitals are working together to improve their outcomes by implementing 50+ lean improvement activities over one year and providing lean improvement training and coaching for 300+ hospital professionals. Funds will support lean coaching and training for the last cycle of the three-year program.