In this episode, Nick Chmielewski speaks with Rebecca Altman, MBA, RN, senior vice president and chief administrative officer at University of Maryland Medical Center's Midtown Campus; and Lowell Hardin, MSN, RN, NRP, NHPD-BC, a senior managing consultant at BRG. They unpack what it takes to improve emergency department (ED) throughput—without ignoring the culture that makes change stick. Drawing on a yearlong engagement at Midtown's ED, they share how leadership visibility, trust-building, and consistent standards set the foundation for performance improvement and resulted in a safer, more collaborative environment and measurable gains in access to care.