Given the recent reports on much-needed healthcare quality improvement in the U.S. we suggest that it is now time to adopt a systemic perspective to measuring quality in U.S. healthcare and tracking it closely to hospital financial performance. Using Donabedian’s (1966, 1968, 1988) Structure-Process-Outcome (SPO) classification we attempt to offer a multi-level conceptual framework tying in the antecedents to and outcomes of patient care quality that can be used by U.S. hospitals to improve the quality of care available to patients and ensure their own viability over the long run. We also address the measurement challenges for a future empirical measurement and conclude with implications for healthcare research and the medical practitioners and U.S. hospitals.