'A deficiency of will and ambition': a conversation with Donald Berwick. Interview by Robert Galvin.

A leading champion of health care quality sees the slow pace of improvement as evidence of a failure of provider leadership and concludes that external pressure will be necessary to move the system toward meaningful change. Donald Berwick, founder of the Institute for Healthcare Improvement, supports performance incentives for hospitals and health systems. But in this interview with Robert Galvin, director of global health care at General Electric, Berwick expresses skepticism about the value of "pay-for-performance" schemes for individual doctors and nurses and emphatically condemns increased patient cost sharing as an appropriate tool for increasing the efficiency of the health care system.