Batalden and Davidoff recently proposed to define quality improvement as "the combined and unceasing efforts of everyone—health care professionals, patients and their families, leaders, researchers, payers, planners, educa-tors—to make changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning)" (Fig. 1) (9). This means that "quality improvement is not tools and methods. The tools and methods help us to work on the work of improving our work"(10). Quality improvement is not a project that starts and ends at certain times, and it is not for a special group of "quality people"—but a part of the daily work for everyone.
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