Significant problems with the quality and safety of care seem endemic in all healthcare systems. In a recent systematic review of case note review studies, over 9% of patients admitted to hospital are harmed by error.1 Furthermore, many patients do not get the treatment that would be effective for them and many more have care that is inefficient.2 When any problem is investigated the solution may appear simple. However, getting necessary systematic change always seems difficult.

The quality improvement movement, and latterly the safety movement, came late to health care compared to other industries. Perhaps this is in part a reflection of the additional complexity of health care. While problems with care are not new, in the past 20 years or so there has been a huge increase in the number of effective treatments and in their complexity, with an increase in public concern about the safety and quality of care.3 There is much theory and practice to be learned from other industries. But theory alone is not enough and there is a clear imperative to find practical ways of addressing quality and safety in local healthcare settings in a robust and reliable way—we owe this both to our patients and to ourselves.

In 1991 we helped to found the journal now called Quality and Safety in Health Care. We sought to provide a forum for the exchange of scholarly ideas, original research, debate and discussion, and examples of good practice. The survival and growth of the journal attests to the importance of the field and those initial aims. Although there may now be an improved understanding among a few about what is wrong with health care and how it could be put right, the fact that systematic problems with care—for example, infection control in hospital …