Improving Patient Care

This issue marks the debut of Improving Patient Care, a new Annals section that will feature articles about quality improvement and patient safety. The new section will be about the organization of practice rather than the clinical content of care. To understand this distinction, consider Runciman and colleagues' paper in this issue, Error, Blame, and the Law in Health CareAn Antipodean Perspective (1). The subject is the characteristics of health care that cause, or contribute to, errors. Most errors do not involve moral culpability. Instead, they are the consequence of systems whose designers were not fixated on reducing errors. Rather than blame the individual, we should fix the system. The issues raised by the authors cut across the full spectrum of health care, and the solutions focus on altering the organization of care. The history leading up to Improving Patient Care reflects the commitment of the American College of Physicians to helping physicians improve. In 1997, the College began a partnership with the HMO Group (now the Alliance of Community Health Plans) and assumed operating responsibility for its journal, HMO Journal. The College and the HMO Group recruited an editor, H. Gilbert Welch, MD, and renamed the journal Effective Clinical Practice. The revamped journal debuted in 1998. Effective Clinical Practice was an influential, vibrant presence for 4 years before the College reluctantly closed it to reduce expenses in an increasingly tight financial climate. In this misfortune, we saw an opportunity to enhance Annals while sustaining an important element of the College's mission. We hope that the principal audience for Improving Patient Care will be the practicing physician, but we hope to attract other health professionals who will read Annals because every issue has something useful to say about improving clinical practice. We made one stipulation: The editors would not reduce the traditional content of Annals in order to publish Improving Patient Care. Adding pages is expensive. Fortunately, the College has a publishing partner, the Agency for Healthcare Research and Quality (AHRQ). The Agency agreed to help support the costs of publishing Improving Patient Care because of its commitment to disseminating quality improvement and patient safety research to a large clinical audience. The leaders of the Agency support this effort whether published research in Annals is sponsored by AHRQ or by others. Carolyn Clancy, MD, Director of AHRQ, shares our belief that we are acting in the public interest by undertaking a partnership that will extend the legacy of John Eisenberg, MD, a leader of the College and later the director of AHRQ until his death in 2002. The person who will be responsible for shaping Improving Patient Care is Sankey Williams, MD, the Sol Katz Professor of Medicine at the University of Pennsylvania and chief of its Division of General Internal Medicine. He served as the Editor of the Journal of General Internal Medicine for 5 years and will be an Associate Editor of Annals. He will guide the review process for articles on quality improvement and patient safety and will help to make the final decisions about which articles to publish. All the pieces are in place for a successful outcome for Improving Patient Care. The editorial staff is ready to do its part. Now we need the best efforts of the volunteers who are the heart of this journal: authors, reviewers, and readers. The tangible results that Annals helps to achieve depend on our collective efforts. If we all do our jobs right, we can share in the satisfaction of having served a vital public interest: more efficient, more effective, and safer patient care.