The need to advance a quality agenda in the American health care system has never been more urgent. Yet current initiatives, including "pay for performance" programs, are not generating desired improvement in health care. A major reason is the failure of policy, markets and regulation to engage physicians, arguably the most significant drivers of what care is delivered. On March 28, 2003 in Chicago, Alice G. Gosfield and James L. Reinertsen, MD, FACP, convened, with the generous support of Sanofi-Synthelabo, a unique meeting of 30 senior leaders (CEOs, CMOs, Senior VPs) from a variety of leading institutions around the country  including Intermountain Health, Pacificare, Sutter, Scripps, Massachusetts General Hospital, CareGroup's Provider Service Network, HealthTexas (Baylor), Hackensack University Medical Center, Catholic Healthcare Partners, Mayo, EBM Solutions, Anthem, Institute for Clinical Systems Improvement, Oregon Health and Sciences University and others to consider, react to and develop further ideas first expounded in the AGG Note on 'Gosfield's Unified Field Theory'. This theory, which Reinertsen and Gosfield now seek to move to practice and application ("the Unified Field Theory-Applied ["UFT-A"])   posits how to use clinical practice guidelines to drive physician payment and many other aspects of the health care system. The purpose of such an approach is to (1) give physicians back more time to develop healing relationships with their patients; (2) improve quality; (3) standardize, simplify and make more clinically relevant the physician work environment; and (4) thereby make the entire health care system more consistent with overarching quality driven principles that speak to physicians the way they think.

The discussion was met with significant enthusiasm. Gosfield and Reinertsen have now written a white paper, "Doing Well by Doing Good: Improving the Business Case for Quality" which is available in both an Executive Summary as well as in the full version with footnotes and Appendices.Informed by the conference discussions, the paper considers

  • Current barriers to a physician business case for quality,
  • The limits of current attempts to address the business case,
  • The centrality of physicians to the American health care system,
  • Why physician time and touch with patients are essential quality problems,
  • Five principles for change which could revolutionize health care,
  • How clinical practice guidelines can provide a firm foundation for a unified system to reorder major aspects of health care delivery and accountability, not just for physicians but throughout health care; and
  • Implementation challenges that will have to be addressed to make the theory real.

The goal of the paper is to stimulate rapid-fire trials in multiple venues. The conference attendees were interested in remaining in contact regarding initiatives, experiments and experiences with these ideas. We have now established a listserve at for those who seek to communicate in an on-going way on these issues. We are hopeful this will be the beginning for broader initiatives that will expand to others.