Achieving accountability for health and health care.

There is no well-established mechanism at the local level to discuss or manage the balance of investments in health care and the other social determinants of health. We propose the development of voluntary regional organizations and/or use of current organizations to work with stakeholders of the health system to 1) review local data on health, experience and quality of care, and costs of care (Triple Aim); 2) create shared goals, actions and investments to meet the Triple Aim; and 3) involve citizens in local delivery system reform and stewardship of financial resources. These accountable health communities (AHCos) would contribute to co-creating a sustainable health system.

Changing the culture of patient safety: leadership's role in health care quality improvement.

Background: For two decades health care workers have been struggling, with varying degrees of success, to use the principles of continuous quality improvement (CQI) to improve the quality of patient care. The Institute of Medicine report To Err Is Human prompted most hospitals to turn their attention to the pandemic of medical errors and to the realization that without changing the culture of blame, and thus releasing an avalanche of information, major improvement would not be possible. This article describes one community hospital's approach to changing its organizational culture and the critical role of leadership in that transformation.