Americans were proud to claim that our healthcare system was the best in the world—until we discovered that it wasn't. Reports in the early 1990s that patient care was riddled with medical errors served as an important wake-up call, and within a few years we were scrambling to figure out what to do about it. The revelations that our life expectancy and child mortality were worse than in dozens of other countries added insult to injury, and the enormous variations in practice patterns across the country disclosed that medical practice was more like a lone cowboy mentality (“I do it my way, don't bother me with rules or requirements”) than scientific practice. For years the only brakes on poor performance were malpractice suits, and they were heavy handed, inadequate governors of practice. But the error mongers spawned evidence based medicine, which in turn begat clinical practice guidelines, a spate of “best practices,” and a focus on team and individual …