1. Schroeder, Patricia RN, MSN, MBA

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A wise sage once stated that the new era of health care will be defined not just based on what we choose to create from the current chaos, but more so based on what we choose to leave behind. Choosing to be or not to be anything in today's volatile environments sounds like we have more opportunity to decide than what it often feels like. Nonetheless, our movement forward into the new millennium is framed by decisions that we make every day. Those decisions are based on what we value and the vision toward which we think we are moving. The decisions define the journey. What values and beliefs do we hold today that have no place in the future? We know that the science, knowledge, skills, and beliefs that undergird our work and workplaces will emerge differently in the future, but as yet cannot describe how.


Looking back, the people, processes, and progress of improving health care quality have created an interesting journey. Rooted in the 1850s with the work of nurse Florence Nightengale, and the early 20th century with surgeon A.B. Codman, health care quality has lived through many generations of focus and impact. Increasingly regulation for health care quality, as driven by increasing numbers of regulators, has been a hallmark. Quality assurance to continuous quality improvement to more comprehensive performance improvement has been the path. Structure, process, and outcome and the works of Donabedian have provided a rudder to the quality ship.


While several eras of health care quality and its improvement can be easily described, the picture of our work in this new millennium has not yet emerged. To what extent will it be driven by regulation? To what extent will it be driven by current state resources? To what extent will it be enhanced as a science and art? Will the work we do more effectively improve the care and outcomes for the publics we serve?


If the sage is right, and the era is defined by what we choose to leave behind.[horizontal ellipsis] What will it be? It's critical we decide, not by default, but through clear and thoughtful deliberation. It is we who create the new millennium.


Welcome to the future.


Patricia Schroeder, RN, MSN, MBA