ABSTRACT
The recent movements in health care toward enhanced patient safety and quality of care are directed at systemic changes: “quality problems occur typically not because of a failure of goodwill, knowledge, effort, or resources devoted to health care, but because of fundamental shortcomings in the ways care is organized” (Corrigan, Donaldson, Kohn, Maguire, & Pike, 2001, p. 25). Health care is delivered by individuals with personal and pro fessional identities who work within and across complex organizations structured by our economicpolitical-legal system. Fundamental changes, such as those advocated by the Institute of Medicine (Corrigan et al, 2001; Kohn, Corrigan, & Donaldson, 2000) and the Institute for Healthcare
1http:/ / www.ihi.org
Improvement1, require that health care practices, systems, and the cultural assumptions that underlie and reinforce existing behaviors realign in a more effective and sustainable way.
