Respiratory therapy is a continuous service requiring team effort. Quality control is assured only through the active, responsible leadership of the medical director. Standards were defined in 1973 by the Joint Commission on Accreditation of Hospitals, and statements of policy must now be submitted in conformance with these standards. The medical director is the prime mover in this effort. Effective communication with the hospital physician staff, administrators, and trustees is essential. Supervisory control of respiratory therapy must be maintained without sacrificing clinical initiative of therapists. This requires frequent mediation between therapist and primary physician, and continuous supportive effort in patient management. The advances of governmental regulatory bodies place added responsibilities on the director for community accountability. The maintenance of services of high quality is now mandated by the public. Consistent delivery of these services is largely determined by the precept and example of the medical director; his dedication and enthusiasm will be reflected by the efforts of the respiratory care team.