Improving operational performance in hospitals is complicated, particularly if process improvement requires complex behavioral changes. Using single-loop and double-loop learning theory as a foundation, the purpose of this research is to empirically uncover key improvement behaviors and the factors that may be associated with such behaviors in hospitals. A two-phased approach was taken to collect data regarding improvement behaviors and associated factors, and data analysis was conducted using methods proposed by grounded theorists. The contributions of this research are twofold. First, five key behaviors related to process improvement are identified, namely Quick Fixing, Initiating, Conforming, Expediting, and Enhancing. Second, based on these observed behaviors, a set of force field diagrams is developed to structure and organize possible factors that are important to consider when attempting to change improvement behaviors. This begins to fill the gap in the knowledge about what factors drive effective improvement efforts in hospital settings.