Performance improvement in medicine based on evidence-based guidelines is a persistent challenge for clinicians. Challenges include deficiencies in collaboration, resistance to change, complex algorithms, inadequate resources, and inability to collect data and provide feedback. In severe sepsis this is further compounded by the perceived importance of early intervention and considerable conflicting literature. The bundle concept first adopted for mechanically ventilated patients and then for central line insertion, has now been applied to care for the patient with severe sepsis. The bundle concept in severe sepsis facilitates the provision of best practice consistent care to eligible patients with a structure to measure compliance. Time sensitive bundle indicators allow for uniform data collection and reporting. Successful modification of clinical practice may require months or years. The success of the program relies upon the cross-departmental collaboration and support generated before implementation and the ability to deliver timely feedback to facilitate change in performance.