The Sullivan County Regional Health Department (SCRHD) has utilized the Baldrige Criteria for Performance Excellence as a business framework since 2005. SCRHD has united the Baldrige framework and the Ten Essential Public Health Services into a work system design that has allowed them to deploy principles of performance management, strategic planning, and process improvement throughout all levels of their organization. Successful implementation of the Baldrige framework requires buy-in at all levels of the organization and a keen awareness that key work processes, systematically scheduled assessments, global and departmental indicators, as well as suggestions for process improvement fully align with the Mission, Vision, Values, and Core Competencies of SCRHD. In 2011, SCRHD earned their highest level of distinction by receiving the Level 3 Achievement Award which recognizes organizations that have demonstrated, through their commitment to and practice of performance improvement principles, significant progress and results in building sound processes. A level 3 achievement award was received again in 2015.