Improving the quality of health care: who will lead?

In this review, Becher and Chassin discuss the persistent “quality chasm” that exists in the health care system. They outline quality problems and their most prominent causes, including a series of obstacles that prevent necessary improvements. The authors conclude by emphasizing the need for dynamic and visionary leadership to effectively bridge current gaps in health care quality. They offer a series of avenues from where this leadership may originate (e.g., consumers, purchasers, government, academic centers) as well as strategies for and examples of successful improvement efforts. Overall, this article provides an overview of the challenges facing health care quality improvements and how better leadership must catalyze the movement.