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In the 12 years since QSHC was launched as QHC (Quality in Healthcare) attitudes to quality improvement have changed enormously. Then, in the United Kingdom, quality improvement work largely consisted of medical audit. Results of audit work were usually discussed in clinical meetings with little management involvement. Now there is corporate responsibility—shared between clinicians and managers—for the quality of care, quality improvement, and risk management. The links between improvement in clinical practice and organisational change are widely acknowledged. Quality improvement is less an optional extra, it is more a part of routine practice. And much more is known about the extent of error than 12 years ago. Shocking revelations from public inquiries into the circumstances of scandals have illustrated the frailty of many parts of care systems. Data quantifying the extent of adverse events within many healthcare systems indicate that error is endemic. And, although health systems may differ, many of the circumstances of error and the lessons that emerge from investigations apply in any country. Worldwide, people are trying to find ways of making health care safer and less damaging to patients.

This journal has changed too. Changes in the content have reflected developments in quality and safety improvement. Organisational change and team functioning have become important and recurring themes. Human factors, clinical microsystems, and decision making are some of the topics covered in the past two years that may not have made as much sense 12 years ago as they do now. Many more authors are from outside the United Kingdom and we hope that all papers have generalisable messages accessible to readers worldwide. …