Through providing the current state of quality in health care including current recommendations of the Institute of Medicine, we have painted the picture of the "chasm" that exists in current health care delivery systems. Based on this we have created a path forward for busy health care professionals caring for adolescents with rheumatic conditions to be able to take charge of current practice by convening a group of interdisciplinary professionals to learn new improvement knowledge and skills to improve processes of care. The clinical value compass and the registry provide frameworks for tracking results over time and that improvements are truly seeing whether resulting in better outcomes. It is hoped that identifying the key resources and materials that can help professionals "work on the work" to begin improving both the care we provide and the outcomes desired by adolescents, families, and health care providers. After all, "every system is perfectly designed to get the results it gets." It is up to the members of the rheumatology microsystem to design the system to be the best it can be with the goal of achieving the best care for young people in adolescent rheumatology.

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