Unnecessary variation and overuse in care are associated with increased length of stay. Efforts to improve efficiency without physician leadership and buy-in have been unsuccessful. Congestive heart failure (CHF) is the most frequent admitting diagnosis and is associated with increased hospital length of stay. This performance improvement initiative used Six Sigma methodology to reduce CHF length of stay at a community hospital. Daily rounding, prioritization of CHF patients for left-ventricular (LV) assessments, and standardization of orders accounted for improvements in delivery of care. Turnaround time for LV assessments was reduced from a mean of 2.2 days to a mean of 0.78 days. Use of standardized CHF order sets by physicians rose from 25% to 72.6%, and length of stay was reduced from 7 days to 4 days (P = .00). Physician leadership, interdisciplinary team dynamics, and standardization of practice play crucial roles in reducing length of stay.