It wasn't so long ago that we in health care believed that the best care was completely and totally individualized.[horizontal ellipsis] to the client, by the provider. Little was to be standard, and most was to be spontaneous and driven by the client's presentation and the provider's intuition. Care and service based on this perspective would result in difficulty even predicting outcomes from one client to another, let alone managing clinical outcomes for individuals or groups. No longer is this perspective considered vogue, or even the best approach. While individulization of care to each patient is essential given the nature and intimacy of health care, science has demonstrated the need to decrease variation in approaches to care, in order to enhance effectiveness and set the stage for the most positive end results. Identifying clinical outcomes for individuals and groups, and then managing to and for them, drives us to a different mindset, research focus, and approach to care delivery. It likewise reinforces the shift away from a "compliance" focus for quality efforts, and an emphasis on measuring achievement of evidence-based, client focused outcomes, and methods used to achieve them.

This issue of Journal of Nursing Care Quality (15:1) features articles replete with examples of cutting edge approaches to both managing clinical outcomes and enhancing clinical performance improvement. The insights presented can set the stage for new directions or next steps. Starting with the end results in mind, a phrase that is often repeated, can significantly alter how we carry out the work we do. Identifying outcomes, and then managing to and for them, is an essential focus to performance improvement efforts of this generation.

-Patricia Schroeder, MSN, RN, MBA

Journal Editor