In June 2001, after winning the UK general elections by a landslide, which gave him a second term, Tony Blair invited Michael Barber (case protagonist) to establish and lead the Prime Minister Delivery Unit (PMDU): a small, dedicated performance management structure charged with driving improvements of a few, well-specified service delivery outcomes. Having become keenly aware of the chasm between policy ideas and outcomes on the ground during his first term, Blair wanted to strengthen the British government’s ability to deliver results that mattered to citizens. This case provides background on the delivery approach, developed by Barber and his team, designed to improve government performance. It tracks Barber’s experience as the Head of the PMDU during Blair’s second mandate. The case focuses on the processes involved in establishing foundations, planning, implementing and monitoring delivery, as well as the outcomes achieved during the PMDU’s first four years of operation. The goal of reducing accident and emergency wait times in the National Health System is investigated as an exemplar of how the delivery approach worked in practice. This case is designed to enable discussions on the challenges of implementing an innovative performance management system in the public sector, designed to achieve demonstrable results to citizens and embed a cultural change in government.