Over the past 15 years Americans have become aware that they are not receiving medical care of the highest quality. Concern about quality surfaced in the 1990s with suspicions that managed care companies were skimping on care to increase the bottom line. It resurfaced, in a different way, in the early 2000s with the publication of a widely reported Institute of Medicine study finding that faulty care in hospitals was responsible for between 44,000 and 98,000 avoidable deaths a year and a well-publicized report by Elizabeth McGlynn and her colleagues indicating that more than half of chronically-ill patients do not receive appropriate care.
The movement to improve the quality of health care is a response to these kinds of concerns, and the Robert Wood Johnson Foundation, which has been concerned about quality since the 1970s, has helped to create and establish the movement. The Foundation did not advertise its work to improve quality of care, and until recently it was not a priority area. Perhaps because quality-of-care grantmaking was carried out within the context of chronic care (which was a priority), many staff members did not even recognize that the Foundation was doing so much to improve quality. In this chapter, Carolyn Newbergh, a freelance journalist and frequent contributor to the Anthology series, chronicles the Foundation's efforts to improve the quality of medical care in the United States.