title: Improving health care: national policy and local practice.
abstract: Attention to quality and patient safety in health care has grown substantially over recent years. From 1982, I have been involved in advocating for efforts to improve quality and safety. Four years ago, I was given the opportunity to lead an academic health system - hospitals, doctors, and a medical school. This article recounts the shift in perspective, from a focus solely on national policy, to one now of changing local practice. Both are important and needed. The past 25 years have seen a large scale shift in the way the public at large and especially the medical community view the state of quality and safety in health care. I have been privileged to participate in this transformation at the national level in several roles, and I would like to describe that evolution. Now, however, I have the job of leading an academic medical enterprise, and am challenged by the task of putting lofty national ideas into practice at the local level. I am very committed to this effort, but am sobered by the challenges we face.
authors.affiliation: Chapel Hill, North Carolina, USA. roper@med.unc.edu
authors.forename: William L
authors.initials: WL
authors.lastname: Roper
mesh_terms: D006291:Health Policy; D006801:Humans; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012449:Safety; D014481:United States