The adoption of the Balanced Scorecard philosophy of measure, monitor and manage by The Hospital for Sick Children (SickKids) has resulted in SickKids' staff understanding, appreciating and ultimately being able to accept the enhanced transparency and accountability around performance, at both the system and hospital levels. The leadership of the organization observed these differences after initial SickKids scorecard update meetings, realizing this was not a flavour of the month but a totally new way of operating in a quest to achieve SickKids' vision and mission. Almost immediately, the internal culture began to shift as staff better understood how their roles actively contribute to the organization's ability to execute on its strategy. Based on 2010 staff engagement results, 70% of staff "see a direct link between personal work objectives and SickKids' strategy," while 60% were familiar with the newly released strategic plan, unprecedented results based on current benchmarks. This article provides an overview of the SickKids strategy management system, outlining both best practices and the journey from its launch to induction into the Balanced Scorecard Hall of Fame. Performance, at all levels across the enterprise, has shown measureable improvement with the introduction of the comprehensive strategy management system.