Can the sum of projects end up in a program? The strategies that shape quality of care research

[...]this chasm separates the concepts of a "QI project" from a "QI program". To do so, the performance of individuals and organizations should be continuously measured, not in a desire to reprimand or punish but to enhance and celebrate. [...]performance measurement and improvement are seen as parallel tracks to the practice of medicine, there can be only research studies that may have much less ability to alter culture, mind set, and perceived responsibilities.