ABSTRACT

Every field is built on a set of metaprinciples. These principles comprise the paradigm of a given field and serve as a set of disciplinary commitments that guide members’ behavior (Kuhn, 1977). Medicine, for example, is driven by the Hippocratic ethic of “first do no harm,” as well as a commitment to engage in practices that are informed by science. Increasingly, quality improvement programs (American Psychological Association, 2009; Deming, 1982, 1986) that incorporate guiding principles associated with business and economics have also begun to shape medicine (Berwick, 2004; Institute of Medicine, 2001).