There are five areas of return on investment (ROI) in health care. They are patient outcomes; clinical delivery; operational effectiveness; health system reputation; and financial success. The comparison of impact to investment is the ROI. However, financial ROI typically does not resonate with physicians and does not address enhancing the mission. Instead, ROI needs to be presented in a manner that matters to physicians, other clinicians, chief executive officers (CEOs), and chief financial officers (CFOs), and demonstrating such in a way that keeps the project funded; change is rarely free. Improvement in patient outcomes may generate no revenue, so the patient outcome ROI is often negative, which indicates that preventing an event or achieving a positive outcome is an expense. Clinical delivery involves all aspects of care delivery, including clinical efficiency and clinician satisfaction. Most clinical delivery measures improve by getting smaller, but not all.