Characteristics of the old and new “moral fabric” for physicians. Adapted from Shortell et al.50

Old expectationsNew expectations
Physician responsible only for individual patientPhysician responsible for individual patient and populations of patients
Individual clinical responsibility for patientTeam or group, and patient, responsibility
Credibility and trust largely based on professional mystique and prestigeCredibility and trust based on data and documented evidence of effective practice
Profession determines performance and accountability criteriaProfession and others (governments, purchasers, public, community groups, etc) determine performance and accountability criteria
Physician accountable to patients and the professionPhysician also accountable to health care organisation and external groups>
Organisations exist to serve individual physician's interestsOrganisations exist to serve patient, community and physician interests