Performance of hospitals is central to health system strengthening efforts, yet hospitals often fail to meet the needs of the communities they serve. Globally, 40% countries have fewer than 18 hospital beds for every 10,000 people, the estimated minimum number needed to achieve Sustainable Development Goal 3. Beyond insufficient numbers, priority should be given to improving internal operations of hospitals and their contribution to health systems. Implementing a national vision of the role of hospitals and their contribution to Universal Health Coverage requires a set of policy and operational levers that focus on system design, autonomy, accountability, regulation and people’s participation; efficient provider payment methods with monitoring and feedback mechanisms to reward hospitals that perform better; and ensure availability of adequate resources. The Chapters proposes three strategic approaches for improving hospital performance: (i) ensuring that hospital managers have the required competencies; (ii) having governance and operational frameworks; and (iii) monitoring and rewarding individual and collective practices.