This question aligns with Organizational Culture and Leadership , focusing on sustainable performance improvement. Option D is correct because successful improvement requires clear alignment between goals, mission, values, behaviors, and measurement systems . CPXP principles emphasize that organizations must not only set clear expectations but also ensure that staff behaviors and performance metrics are consistently aligned with those goals. This creates accountability, reinforces desired behaviors, and drives lasting cultural change. While dashboards (A, B) and advisory councils (C) are valuable tools, they are supportive mechanisms rather than the core strategy. Without clear goals and alignment, these tools lack direction and impact. Sustainable improvement is achieved when everyone in the organization understands the goals, is measured against them, and demonstrates behaviors that support patient-centered outcomes.