An ABC News/Washington Post survey in 2003 found that for the first time, 54 percent of Americans were dissatisfied with the overall quality of health care in the United States.

In 2006, the Commonwealth Fund released results of an international survey that measured 37 areas of quality. Despite spending 16 percent of its gross domestic product on health care, more than twice the average of other industrialized nations, the United States scored only 66 out of 100. Other studies have shown that life expectancy in the United States lags behind that of Japan, Italy, France, Canada, Germany and the United Kingdom. Thousands of Americans die every year from errors in hospitals. Millions are uninsured or underinsured.

Hand-in-hand with accepting the challenge of improving the health-care delivery system and the outcomes it produces, hospitals and health care providers also must be convinced of the business justification for investing in quality. Cynicism about the business case for quality improvement is an anomaly unique to the health care industry. It is born of a third-party payer system, the lack of a commonly accepted definition of health care quality and how to measure it, and questions about how investments in quality will be rewarded.

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