Abstract
The article argues that incremental improvement of, or "tinkering" with, health care delivery is taking too long and leaves unacceptable gaps in health care quality and service. It lists five common types of quality improvement "leaps" that have proven across studies to improve the integration of care during hospital and emergency department discharge, to bring mental health and substance abuse treatment into primary care, and to allow better management of chronic diseases. It also lists five key tasks that organizations need to accomplish in order to make such leaps and then describes four ways that consumers, employers, consumer advocates, and investors force the stubborn "bullfrogs" to take a big jump forward.