Shepherding change: how the market, healthcare providers, and public policy can deliver quality care for the 21st century.
BACKGROUND
Data are scarce that inform the ways consumers of health care and caregivers help improve the care that is delivered. The healthcare system is quite broad. To improve it, we first must understand it, understand its various subsystems, and understand how they shape individual behavior.


CONCLUSIONS
Both consumers and providers can effectively improve health care. An example of an influential consumer is provided, focusing a successful effort to improve care in the intensive care unit. The overall model for improving outcomes assumes providers can be classified into high-quality and low-quality providers. The model then aims to increase the number of people exposed to high-quality caregivers. There are three primary levers for driving this change: using market forces, provider improvements, and policy change. This article touches briefly on the first and focuses on the second and third.


CONCLUSIONS
A number of grassroots programs highlight ways providers can improve care by approaching patient safety and quality as a science. In addition, the Josie King Act and its legislative progeny provide some hope that a new policy environment can reward and reinforce providers' efforts to drive up safety and quality.
Kennedy
Patrick
P
U.S. House of Representatives, Washington, DC, USA.
Pronovost
Peter
P
D019033:Delivery of Health Care, Integrated / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000639:trends*; D005544:Forecasting; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D009936:Organizational Innovation; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D017751:Safety Management / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000639:trends; D014481:United States; D014492:United States Public Health Service / Q000458:organization & administration