Fig. (1) The transformation of a maze with a jumble of documents, guidelines and indicators to a structured House with different integrated levels. In the House is described what we do in the Northwest Clinics. The roof contains the Mission Statement of the organization.The top floor contains documents concerning Vision, strategy & policy and core business. Documents concerning business control are stored at the second floor. All health care processes are described at the first floor. In the Achievement books (ground floor) each discipline and department has described how we do it. The Achievement books, with a fixed format, contain facts and figures of each department and discipline including their annual plan and report, core business, organization chart, practical aspects, results on performance indicators and improvement actions. The green elements are managed top-down; the blue elements bottom-up.