Many Swedish health professionals, including several authors of the articles in this issue, regularly visit the United States to learn about our health care ideas, including our quality improvement efforts. We can also learn from our colleagues and their work in Sweden. For example, they can-and do-collect information and make changes across their whole country, which is nearly impossible in the United States. After all, Sweden is a country of 9 million people with a national health system and government that is the principle payer of care and owner of hospitals and clinics. Taxes are high to pay for their extensive public social services. Over the centuries, Swedes have come to trust their government and given it a large role. In the United States, most voters say they are opposed to big government and do not like how it does things. The recent large tax cuts are another statement that a small federal government is preferred in the United States. Because of their trust, Swedes let their government run their health service, develop long-range health plans, and carry them out. They are willing and able to collect national health care data to help make improvements in ways that we seem unable to do in the United States. Four of the articles in this issue use two such remarkable Swedish data sources.

The first two articles here use a 2002 Swedish government survey of every clinic and hospital in the country to ask how they are progressing on their quality improvement efforts. Of the respondents, 31% reported improvements and 80% said their improvement work was worth the effort. None of the respondents said the care provided in their unit was less than average. The second of these two articles by Stefan Book and others analyzes the responses of managers who say they have made improvements. This sample is large enough to allow for analysis of the environment associated with improvement.

The second remarkable data source used in two articles here by Pukk et al consists of every formal patient complaint made by Swedish patients about their own health care. These complaints are followed up and, if appropriate, patients are compensated. This provides a check on the validity of these complaints. Do women complain more than men? If so, are these complaints equally likely to result in compensation? In the second article by Pukk et al, these two data sets are merged so the following question can be asked. Is there an association between the manager's perception of quality and the frequency of patient complaints? No. This negative finding suggests the need to have bench mark comparative performance data available to managers as a reality check.

The next two articles in this issue by Olsson et al describe the development of two survey instruments to be used to assess the organizational environment's potential for making improvements. One of these surveys was developed by David Gustafson in Wisconsin using expert opinions from the United States. Olsson replicates this method for Swedish health care managers and finds some differences. Olsson shows how the scores from his survey are associated with a greater likelihood of improvement in a Swedish hospital, thus showing its potential as a useful tool to assess the climate for change.

The final article by Striem et al describes the familiar struggles at a Swedish hospital to bring about improvements in patient care.

In short, this is an excellent set of articles using unique large data sources to tell the world about quality improvement, patient complaints, and organizational climate for improvement.