Introduction

As academic researchers, we have collectively and individually been interested in health reform for many years. Health reform at its most basic involves making changes (which are hoped to result in improvements) in the performance, operations, structures, process, or outcomes of health systems. (Of course, a key part of reform is to decide what to keep and what to change. Some things may be working well and not need reforming.) Nevertheless, reform is usually construed as a set of high-level, macro-system considerations concentrating on change. We have also been interested over the years in efforts to enhance the quality of care and make things safer for patients. Healthcare quality is a multi-faceted concept which embraces a number of dimensions, including: safety, cost-effectiveness, access, responsiveness, patient centeredness, and equity. Patient safety is about the prevention of harm to patients. Quality and safety interventions are typically thought of as targeted initiatives at the mid-to lower-levels of health systems-a set of meso-or micro-system considerations.