Evidence of shortcomings in the quality of our health care is substantial.^{(1) (2) (3)}  A 1999 Institute of Medicine report estimated that as many as 98,000 Americans die each year as a result of avoidable patient safety errors, while the Centers for Disease Control and Prevention has estimated that 90,000 die as a result of hospital-based infections.^(4) (5)  According to the national health system scorecard released by the Commission on a High Performance Health System, anywhere from 100,000 to 150,000 deaths could be prevented each year if the U.S. were able to raise standards of care to benchmark performance levels achieved within this country and abroad. The Commission's scorecard also documented enormous variation in the delivery of care—nationally, regionally, and locally.

The Program on Health Care Quality Improvement and Efficiency is guided by the belief that improvements in health care quality are most likely to occur when the need for change is acknowledged and publicly recognized, when appropriate incentives are in place, and when those who deliver, purchase, and regulate care have the capacity to initiate and sustain change.