​John W. Moran and Grace Duffy wrote an article entitled “Starting and Sustaining a Complete Quality System” that was featured in the August 2010 Quality Texas Foundation Update. The article describes a complete quality system and focuses on the processes that need to be in place to maintain consistency in quality. It introduces the use of an improvement model and focuses on the importance of assessing customer needs. Leadership buy-in is crucial for a quality improvement initiative to work in starting and sustaining this system.