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Darrell A. Campbell Jr, MD; E. Patchen Dellinger, MD

JAMA. 2009;302(14):1584-1585.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The US health care system is plagued by a paradox. Creativity is prized and innovation is commonplace, but clinical quality, at least as judged in comparison with other industrialized countries, is seen as lackluster.¹ One aspect of this problem is the large gap between the generation of evidence, which would be produced by a well-conducted clinical trial, and the reliable implementation of that evidence in the community hospital.² One of the difficulties in translating and applying evidence to the bedside might relate to hospital organization.³

The problems start at the top. The hospital CEO has resources but often no clinical credentials, and works with the physician leader, who has clinical credentials but no resources. This often results in ambivalence about strategy and a corresponding lack of a clear and well-accepted plan. Strategic confusion also stems from the strong professional identification physicians . . . [Full Text of this Article]

Author Affiliations: University of Michigan Health System, Ann Arbor (Dr Campbell); and Department of Surgery, University of Washington Medical Center, Seattle (Dr Dellinger).

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