Physicians' professional responsibility to improve the quality of care.

Physicians have long recognized a professional responsibility to improve the quality of care. However, that responsibility should be evolving in light of developments in both the science of quality improvement and the ethical base of professionalism. Over the last 30 years, quality science has moved from static/structural measures to a much more sophisticated set of outcome and process issues. It has also self-consciously integrated notions of continuous improvement. The ethical base of professionalism is also more dynamic, today emphasizing the policy activist attributes of so-called civic professionalism. The combination of modern quality measurement/improvement and activist professionalism is a virtual call to arms for the profession to advocate care that is systematically better. Recent developments in the domain of quality dealing with medical errors can be used to illustrate this synergy, and provide a set of mandates for the new professional commitment to quality.