How does an emergency department (ED) go from the 6th to the 99th percentile in patient satisfaction, while improving dramatically in virtually every performance and efficiency category? If it were a Toyota vehicle-manufacturing plant, a key enabler would be a rope strung along each production line above team members, the Andon Cord. The cord can be pulled by anyone encountering a quality problem or needing assistance from the team leader. When the Andon Cord is pulled, music and lights alert the team leader, and everyone’s attention is turned to collaborate and solve the problem.